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REPORT 

OF  THE 

Committee  on  Inquiry  into  the  Departments 

of  Health,  Charities,  and 

Bellevue  and  Allied  Hospitals 

IN  THE  CITY  OF  NEW  YORK 


APPOINTED  BY  THE 


Board  of  Estimate  and  Apportionment 


GEORGE  McANENY,  Chairman 

President  of  the  Borough  of  Manhattan 

GEORGE  CROMWELL 

President  of  the  Borough  of  Richmond  . 


"   Committee 


Investigation  and  Report  under  the  direction  oe 
HENRY  C.  WRIGHT 


CITY  OF  NEW  YORK 
1913 


TABLE  OF  CONTENTS 

FAOEB 

TABLE  OF  CONTENTS 3 

INDEX 773-788 

SECTION  I.    INTRODUCTIONS  AND  SUMMARIES 5-98 

1  Letter  of  Transmittal 7 

2  Introduction  by  the  Committee n-13 

3  General  Introduction  by  the  Director 15-18 

4  Summaries  of  Findings,  Conclusions,  and  Recommendations 

of  all  Sections 19-98 

n.     CITLZENSHIP,  RESIDENCE,  AND  DEPENDENCE  OF  PUBLIC 

CHARGES 99-346 

1  Aliens,  Non-Resldents,  and  State  Poor  in  City  Institutions . . .  99-245 

2  Admissions  to  City  Homes  (Almshouses) 247-346 

m.     SOME  HOSPITAL  PROBLEMS 347-404 

1  Clinical  Records  in  Bellevue  Hospital 349-357 

2  Autopsy  Findings  in  Bellevue  Hospital  Compared  with  Clinical 

Diagnoses 359-368 

3  Distribution  of  Ward  Space  in  Bellevue  Hospital 369-380 

4  Transfer  of  Patients  to  and  from  Bellevue  Hospital  and  to  and 

from  Kings  County  Hospital 381-399 

5  The  Morgue  Service 401-404 

IV.    RATIO   OF   NURSES    TO    PATIENTS    PROPOSED    FOR    MU- 
NICIPAL HOSPITALS 405-410 

V.     CHILDREN'S  SERVICES  IN  THE  MUNICIPAL  GENERAL  HOS- 
PITALS IN  MANHATTAN  AND  THE  BRONX 411-423 

VI.    PHYSICAL  EXAMINATION  AND  EMPLOYMENT  OF  DEPEN- 
DENTS IN  CITY  HOMES  (ALMSHOUSES) 425-454 

Vn.     CARE  OF  OUT-PATIENTS 455-545 

1  The  Out-Patient  Department  of  Gouvemeur  Hospital 457-468 

2  Suggestions  for  the  Organization  of  a  Public  Out-Patient  De- 

partment    469-517 

3  Sickness  in  the  Home  and  Proposed  Health  Center 5^9-545 

Vm.    HOSPITAL  EMPLOYEES 547-577 

1  Hospital  Helpers S49-566 

2  Proposed  Salary  and  Wage  Schedule  for  the  Department  of 

Public  Charities S67-577 

IX.    FOOD,  BUILDINGS,  AND  CONTROL  FORMS 579-721 

1  Handling  of  Food  and  Food  Waste 581-630 

2  Character  and  Costs  of  Hospital  Buildings 631-682 

3  Internal  Control  Forms  Suggested  for  Bellevue  Hospital.  . .  683-721 

X.     SOME  PROBLEMS  AND  REORGANIZATIONS 723-773 

1  Proposed  Reorganization  of  the  Medical  Service  in  Bellevue 

Hospital 725-759 

2  Some  Problems  Common  to  all  the  Departments 761-772 


Section  L— INTRODUCTIONS  AND  SUMMARIES 

1.  Letter   of  Transmittal 

2.  Introduction   by   the    Committee 

3.  General    Introduction    by   the    Director 

4.  Summaries  of  Findings,  Conclusions,  and  Recommendations 


LETTER  OF  TRANSMITTAL 


To  THE  Honorable,  The  Board  of  Estimate  and  Apportionment. 

Gentlemen: 

The  Committee  on  Inquiry  into  the  Departments  of  Health,  Charities, 
and  Bellevue  and  Allied  Hospitals,  appointed  in  accordance  with  a  resolu- 
tion of  your  Board  on  October  26,  1910,  herewith  submits  its  report. 

For  reasons  of  economy  and  convenience  the  various  sections  have  been 
published  as  monographs,  for  distribution  to  those  who  may  be  interested 
in  the  particular  subject  of  a  section,  and  have  been  submitted  to  you  from 
time  to  time. 

Respectfully  submitted, 

George  McAneny,  Chairman, 

President  of  the  Borough  of  Manhattan 

George  Cromwell, 

President  of  the  Borough  of  Richmond 

New  York,  December,  1913. 


INTRODUCTION 


INTRODUCTION 

By 
The  Committee 

The  investigation  assigned  to  this  Committee  by  the  Board  of  Estimate 
and  Apportionment  deals  with  a  field  having  no  established  standards.  No 
standards  exist  by  which  to  judge  the  efficiency  of  hospital  practice  or  of 
almshouse  operation.  Even  the  amount  of  food  required  by  patients  or 
inmates  seems  not  to  have  been  determined.  Experts  do  not  exist  who  could 
test  the  operation  of  our  institutions  by  a  cursory  survey  and  comparison 
with  similar  institutions.  Under  the  circumstances,  it  seemed  advisable  to 
the  Committee  to  select  for  the  inquiry  an  experienced  investigator,  and 
one  familiar  with  institutional  problems.  Accordingly,  Mr.  Henry  C. 
Wright,  of  the  Russell  Sage  Foundation,  was  selected.  Mr.  Wright  had 
made  an  extended  examination  of  the  fiscal  control  of  state  institutions  in 
several  states,  an  investigation  which  has  influenced  in  many  states  legisla- 
tion dealing  with  institutions.  Mr.  Wright  was  made  Director  of  the  in- 
vestigation and  called  about  him  a  staff  of  men,  each  familiar  with  certain 
phases  of  institutional  work.  He  has  consulted  constantly  with  leading 
physicians  in  this  and  other  cities,  and  his  conclusions  and  recommenda- 
tions have  been  much  influenced  by  their  advice.  His  conclusions  and  rec- 
ommendations we  indorse,  and  submit  them  as  of  the  Committee. 

The  Report  contains  many  recommendations,  varying  in  importance, 
some  providing  administrative  changes  and  some  establishing  standards; 
such  as,  ratio  of  nurses  to  patients,  organization  of  an  out-patient  depart- 
ment, amount  of  food  to  be  provided,  building  costs,  salary  and  wage 
schedule,  etc.  Of  the  various  recommendations,  we  wish  especially  to  call 
attention  to  and  emphasize  the  following  as  being  of  fundamental  impor- 
tance. 

I.    Reorganisation  of  the  Medical  Service  of  Bellevue  Hospital 

The  medical  service  in  Bellevue  Hospital  is  largely  rendered  gratui- 
tously by  physicians  and  surgeons  who  are  engaged  in  private  practice. 
Some  of  the  best  practitioners  in  the  City  are  in  attendance  and  the 
quality  of  service  rendered  is  of  the  highest.  However,  owing  to  the 
fact  that  these  physicians  and  surgeons  have  a  large  private  practice 
which  must  be  attended  to,  the  time  which  they  are  able  to  devote  to  the 
Hospital  is  somewhat  limited,  and  for  a  greater  portion  of  the  time 
the  patients  are  in  charge  of  the  internes,  who  are  recent  graduates 
of  medical  colleges  and  inexperienced  in  the  diagnosing  of  disease 
and  in  the  care  of  patients. 

The  examination  made  by  the  Committee  of  the  condition  of  dis- 
charged patients,  the  length  of  stay  of  patients,  the  character  of  clini- 
cal records,  the  autopsy  findings,  and  the  time  rendered  by  attending 
physicians,  made  it  clear  that  a  more  continuous  oversight  is  needed 
by  experienced  and  highly  trained  men.  The  Hospital  cannot  render 
II 


HOSPITAL   COMMITTEE 

a  satisfactory  service  without  this  oversight.  The  attending  staff  can- 
not be  expected  to  give  much  more  time  than  at  present  given,  without 
sacrificing  their  private  practice,  resuhing  in  a  lessened  income.  It 
seems  necessary,  therefore,  for  the  City,  in  order  to  secure  the  service 
imperatively  needed,  to  compensate  the  physicians  and  surgeons  in 
charge  of  the  Services.  This  compensation  will  enable  them  to  give 
not  less  than  four  hours  daily  to  the  patients.  The  City  must  maintain 
a  better  control  over  the  operation  of  the  Hospital  than  heretofore, 
and  payment  of  the  Chiefs  of  the  Services  by  the  City  will  insure 
such  control. 

Owing  to  the  limited  time  which  could  be  rendered  by  the  attending 
staff  comparatively  little  study  has  been  given  in  Bellevue  to  the 
nature  and  causes  of  diseases.  This  is  very  important,  since  Belle- 
vue, with  its  wealth  of  material,  should  be  the  leading  laboratory  of 
medical  study  in  the  United  States. 

On  recommendation  of  the  Committee,  $29,500  was  included 
in  the  budget  for  1914  for  the  purpose  of  this  reorganization.  This 
amount  of  money  is  to  be  devoted  to  salaries  of  Chiefs  of  SerA-ices  and 
Resident  Physicians  and  Surgeons  in  accordance  with  the  plan  of  reor- 
ganization outlined  by  the  Committee. 

It  is  the  Belief  of  the  Committee  that  Bellevue  reorganized  will  be 
one  of  the  most  efficient  hospitals  in  the  United  States,  and  by  its 
example  will  raise  the  standard  of  efficiency  in  all  municipal  hospitals. 

Proposed  Health  Center 

The  investigation  has  made  it  very  evident  that  great  numbers  of 
patients  are  sent  from  our  hospitals  to  their  homes  before  recovery  is 
completed  and  while  in  a  weak  condition.  Comparatively  little  is 
known  about  these  homes ;  whether  the  conditions  will  speed  or  retard 
convalescence ;  whether  the  resources  of  a  family  will  enable  it 
to  support  the  convalescing  patient.  We  know  nothing  of  the  homes 
whence  patients  come  to  our  hospitals;  whether  the  homes  or  work- 
ing conditions  have  been  largely  contributory  to  the  sickness.  In 
short,  we  are  working  rather  blindly  within  the  walls  of  our  hospitals, 
little  knowing  whence  the  patients  come  or  whither  they  go. 

The  hospital  must  do  some  form  of  field  work,  in  addition  to  the 
social  service  work  now  carried  on  in  a  limited  way,  in  order  to  be- 
come an  institution  efficient  in  the  prevention  and  care  of  disease. 

To  meet  the  conditions  noted  above  the  Committee  has  proposed 
that  the  City  establish  a  Health  Center,  in  which  both  the  Health 
Department  and  Bellevue  Hospital  shall  cooperate.  The  Health  Center 
has  not  been  provided  for  in  the  budget,  but  funds  should  be  appro- 
priated and  the  experiment  started  as  soon  as  practicable. 

Long  Term  Children's  Hospital  on  Blackwell's  Island 

The  Children's  Hospital  on  Randall's  Island  has  never  been  a 
satisfactory  hospital.  Children  sent  there  have  received  inadequate 
attention.  This  has  been  due  in  a  large  measure  to  the  inaccessibility 
of  the  Island.  The  Island  is  so  located  that,  in  all  probability,  it  will 
in  the  future,  as  at  present,  have  no  better  means  of  access  than  a 
ferry.  The  children  of  the  City  very  much  need  a  hospital  for  long 
term  cases.     Such  a  hospital  should  be  located  where  it  is  easily 


INTRODUCTION  BY  THE  COMMITTEE  13 

accessible  to  attending  physicians  and  parents,  and  where  good  air 
and  open  space  abound.  Blackwell's  Island,  with  bridge  connection, 
provided  elevators  are  built,  fulfills  these  conditions. 

It  is  the  recommendation  of  the  Committee  that  such  a  hospital 
be  started  on  Blackwell's  Island  as  soon  as  elevator  connection  is 
assured. 

4.  Physical  Examination  and   Employment   of  Inmates   of   Our   Citv 

Homes  (Almshouses) 
The  inmates  of  our  City  Homes  are  seldom  given  a  thorough  physi- 
cal examination.  Such  as  are  put  to  work  are  assigned  without  ac- 
curate knowledge  as  to  their  strength.  The  Committee  had  a  full 
physical  examination  made  of  about  five  hundred  men  in  the  Home 
on  Blackwell's  Island.  It  appears  from  this  examination  that  there 
are  in  our  almshouses  fully  fifteen  hundred  inmates  able  to  do  light 
mechanical  work  who  at  present  are  doing  nothing.  These  people 
would  be  happier  and  physically  better  if  employed.  The  Committee 
recommends  the  installation  of  sufficient  devices  and  machinery  to 
provide  occupation  for  these  inmates.  The  physical  examination  to  be 
given  to  all  inmates  will  guard  against  an  assignment  which  might 
overtax  their  strength. 

5.  Hospital  Helpers 

The  low  paid  hospital  employees  are  classed  as  Hospital  Helpers, 
and  their  work  ranges  from  menial  labor  to  work  in  connection  with 
the  care  of  patients.  Many  have  served  for  $60  per  year.  Within 
the  last  two  years  this  lowest  grade  of  pay  has  been  practically  dis- 
continued, leaving  the  minimum  at  $120  per  year.  The  very  low  pay 
secures  a  vagrant  class,  subject,  in  a  large  degree,  to  periodic  drunk- 
enness. 

A  study  was  made  by  the  Committee  to  determine  what  efifect  any 
increase  in  pay  had  produced  upon  the  character  and  stability  of 
service.  As  a  result  of  this  study,  which  required  several  months  of 
work,  a  schedule  of  wages  is  recommended  which  raises  the  pay  of 
all  persons  caring  for  the  sick.  Under  this  new  schedule  no  person 
receiving  less  than  $360  per  year,  except  pupil  nurses,  will  render  any 
service  to  the  sick  in  the  hospitals.  The  number  thus  serving  was  ma- 
terially increased  and  the  whole  nursing  service  improved.  This  in- 
crease was  accomplished  without  an  increase  in  the  total  expenditures 
of  the  hospitals.  The  funds  needed  were  secured  by  reducing  the 
number  of  firemen,  of  whom  there  were  many  more  than  were 
needed. 

If  the  economies  recommended  by  the  Committee  be  enforced  with  regard 
to  the  handling  of  supplies  and  food,  and  with  regard  to  collecting  for  the 
care  of  non-residents  and  deportable  aliens,  the  saving  to  the  City  will 
much  more  than  oflfset  any  expenditures  required  for  the  purpose  of  putting 
the  constructive  recommendations  of  the  Committee  into  operation. 


GENERAL  INTRODUCTION 

By 
Henry  C.  Wright,  Director 

In  preparation  for  this  investigation  a  detailed  schedule  of  the  lines  of 
inquiry  which  might  be  profitably  undertaken  was  made.  As  the  work 
progressed,  however,  it  became  apparent  that  only  a  portion  of  the  schedule 
could  be  carried  out  and  it  became  necessary  to  make  a  choice  of  subjects. 
The  subjects  selected  were,  in  the  main,  those  on  which  fundamental  rec- 
ommendations might  be  made;  recommendations  which,  if  carried  out, 
would  automatically  correct  many  minor  defects  in  organization  and  ad- 
ministration. 

In  connection  with  the  Department  of  Public  Charities  the  first  subject 
considered  was  that  of  Hospital  Helpers,  which  classification  includes  prac- 
tically all  low  paid  help  in  and  about  the  institutions.  Serious  complaint 
had  been  made  year  by  year  as  to  the  inefficiency  and  unreliability  of  this 
low  paid  help,  and  repeated  endeavors  had  been  made  to  gradually  increase 
the  rates  of  compensation.  An  inquiry  was  made  to  determine  whether  or 
not  such  increases  as  had  been  made  resulted  in  a  better  class  of  help  and 
more  constant  service.  This  inquiry  lasted  several  months  and  on  its  find- 
ings budgetary  recommendations  were  made.  Much  time  was  devoted 
to  the  formulation  of  these  budgetary  recommendations,  which  were  incor- 
porated in  the  budget  of  1913  but  do  not  appear  in  the  Report.  Additional 
nurses  and  attendants  were  provided  and  the  minimum  wage  of  those 
serving  in  wards  was  materially  increased,  with  the  result  that  the  standard 
of  service  in  connection  with  the  sick  was  raised  in  all  of  the  hospitals  of 
the  Department  of  Charities. 

An  examination  of  the  medical  service  in  the  hospitals  of  the  Depart- 
ment of  Charities  was  not  made,  except,  in  a  very  minor  degree,  in  con- 
nection with  Kings  County  Hospital.  It  became  evident  early  in  the  in- 
vestigation that  a  detailed  examination  of  the  results  of  medical  and 
surgical  practice  could  be  made  thoroughly  in  connection  with  only  one 
hospital.  For  this  purpose  Bellevue  Hospital  was  selected,  in  the  belief 
that  if  the  practice  in  the  largest  and  one  of  the  best  of  the  City  hospitals 
could  be  thoroughly  analyzed  the  recommendations  resulting  therefrom 
would  be  applicable,  in  the  main,  to  all  of  the  hospitals,  and  the  same 
methods  of  inquiry  could  be  subsequently  adopted  in  determining  the 
efficiency  of  the  medical  service  in  each  of  the  municipal  hospitals. 

Inasmuch  as  the  treatment  of  children  has  become  a  specialized  prac- 
tice, quite  distinct  from  the  treatment  of  adults,  it  was  deemed  advisable 
to  examine  the  children's  services  in  a  number  of  the  municipal  hospitals, 
in  order  that  the  problem  of  the  care  of  children  might  be  considered  as 
a  whole. 

The  method  of  handling  the  food  within  the  hospitals  was  given  con- 
sideration. Inasmuch  as  the  Comptroller's  Department  is  responsible  for 
checking  the  amount  and  quality  of  food  received  that  phase  of  the  subject 
was  not  examined,  but  the  amount  of  food  used  and  the  method  of  dis- 

15 


l6  HOSPITAL   COMMITTEE 

tributing  and  serving  were  examined  in  some  detail.  Bellevue  Hospital 
was  selected  for  this  detailed  inquiry;  first,  because  hearty  cooperation 
could  be  secured  in  that  institution  in  carrying  out  recommendations,  and, 
second,  the  results  obtained  in  Bellevue  might  subsequently  be  applied  in 
other  institutions. 

The  character  and  costs  of  buildings  were  examined,  not  for  the  pur- 
pose of  criticizing  existing  buildings  in  the  hope  that  faulty  planning  and 
construction  might  be  corrected  by  alteration,  but  rather  in  the  hope  that 
revealed  defects  in  existing  buildings  might  be  avoided  in  those  yet  to  be 
planned. 

Considerable  time  was  devoted  to  an  analysis  of  the  practice  in  the 
out-patient  departments,  and  for  this  purpose  Gouverneur  Out-Patient  De- 
partment was  selected.  In  examining  the  results  of  this  service  and  the 
condition  of  patients  discharged  from  Bellevue  Hospital  it  became  evident 
that  little  is  known  with  regard  to  home  conditions  of  patients  visiting  our 
public  institutions,  and  it  seemed,  therefore,  desirable  to  make  an  intensive 
study  of  sickness  in  the  homes  in  certain  selected  districts.  As  a  result  of 
the  findings  in  connection  with  the  condition  of  discharged  patients,  both 
from  the  hospitals  and  from  the  out-patient  departments,  a  recommenda- 
tion has  been  made  for  the  establishment  of  an  experimental  Health 
Center,  which  is  designed  to  make  more  eflfective  the  treatment  given  in 
the  hospitals. 

The  administrative  work  of  Bellevue  Hospital  was  examined,  and  a  new 
system  of  internal  control  forms  was  formulated  and  recommended.  This 
internal  control  system,  with  some  modifications,  can  be  adapted  to  each 
of  the  municipal  hospitals. 

When  the  investigation  started  it  was  intended  to  make  a  thorough 
examination  of  the  nursing  service.  Search  was  made  throughout  the 
United  States  to  find  a  person  competent  to  undertake  such  an  inquiry,  but 
no  suitable  person  could  be  found  who  was  in  a  position  to  engage  in  the 
work.  Accordingly,  the  only  phase  of  nursing  work  investigated  was  the 
ratio  of  nurses  to  patients  now  existing  and  that  which  should  exist.  In 
this  connection  a  schedule  has  been  devised  which,  it  is  hoped,  may  serve 
as  a  basis  for  estimating  the  number  of  nurses  needed  for  municipal  hos- 
pitals varying  in  the  number  of  admissions  and  degree  of  acute  and  chronic 
service. 

An  extended  inquiry  was  made  to  determine  the  number  of  aliens 
and  non-residents  cared  for  in  our  hospitals  and  almshouses.  This  inquiry 
was  made  primarily  for  the  purpose  of  ascertaining  to  what  extent  New 
York  City  is  bearing  a  burden  which  should  be  borne  either  by  the  Federal 
Government  or  by  districts  outside  of  New  York  City.  It  is  hoped  that 
the  results  will  form  a  basis  for  legislative  action  which  will  ultimately 
greatly  reduce  the  burden  borne  by  New  York  City  for  the  care  of  this 
class  of  patients. 

A  superficial  examination  of  the  City  Homes  (almshouses)  made  it 
apparent  that  little  was  known  as  to  the  actual  physical  condition  of  the 
inmates,  and  that  large  numbers  were  idle  who  could  readily  do  some  kinds 
of  light  mechanical  work.  To  determine  the  physical  condition  of  the  in- 
mates and  the  proportion  that  might  be  employed  a  thorough  physical 
examination  was  made  of  about  500  male  inmates  in. the  City  Home  on 
Blackwell's  Island.  The  results  of  the  examination  make  it  apparent  that 
large  numbers  who  are  not  now  employed  can  do  light  work. 

A  great  amount  of  time  and  labor  was  put  forth  in  examining  the 


GENERAL  INTRODUCTION  17 

results  of  medical  practice  in  Bellevue  Hospital.  These  results  were  tested 
by  determining  the  length  of  stay  of  cases  with  different  ailments;  the 
condition  of  patients  on  discharge  to  their  homes ;  the  diagnoses  of  read- 
mitted patients  compared  with  their  previous  diagnoses;  the  character  of 
clinical  records;  the  nature  of  autopsy  findings  as  compared  with  clinical 
diagnoses;  the  time  rendered  by  attending  physicians;  etc.  These  findings 
have  been  worked  up  in  great  detail,  involving  several  hundred  typewritten 
pages  of  tables  and  text,  and  have  formed  the  basis  for  the  recommendation 
of  a  somewhat  radical  reorganization  of  the  medical  service  in  Bellevue 
Hospital.  This  reorganization  involves  an  expenditure  on  the  part  of  the 
City  of  $29,500  annually,  which  amount  has  been  provided  in  the  budget  for 
1914.  The  reorganization  seems  necessary  and  highly  advisable,  and  it  is 
believed  that  the  results  obtained  by  the  reorganization  will  be  so  pro- 
nounced and  beneficial  that  they  will  raise  the  standard  of  hospital  practice 
in  all  of  the  municipal  hospitals. 

Free  access  to  all  records  and  most  hearty  cooperation  were  rendered 
by  the  officials  of  the  Departments  of  Health  and  Bellevue  and  AlHed  Hos- 
pitals. The  codperation  was  not  so  free  on  the  part  of  the  Department  of 
Public  Charities,  yet  sufficiently  so  to  enable  the  Director  to  secure  most 
of  the  information  needed. 

Many  important  matters  have  not  been  examined  during  the  investiga- 
tion, as  previously  stated,  because  of  lack  of  time.  The  Committee 
received  a  pressing  and  cordial  invitation  on  the  part  of  the  Commissioner 
of  Health  to  make  a  full  inquiry  into  his  Department,  but  the  only  recent 
activity  of  the  Committee  in  that  Department  was  in  connection  with  food 
and  buildings.  The  Committee  could  have  been  of  marked  service  to  the 
Department  of  Health  in  studying  the  correlation  of  the  different  bureaus  in 
the  Department  and  the  results  of  the  work  of  each.  A  study  of  the  lack  of 
joint  action,  and  of  possible  and  advisable  cooperation  between  the  Health 
Department  and  other  departments  should  be  fruitful;  such  as,  how  school 
children  may  be  most  advantageously  examined ;  how  the  Tuberculosis 
Hospital  Admission  Bureau  may  be  best  administered;  how  the  ambulance 
service  should  be  operated;  how  tuberculosis  and  other  contagious  or  in- 
fectious diseases  should  be  cared  for. 

The  Comptroller's  department  has  given  much  valuable  consideration 
to  accounting  systems  in  connection  with  the  public  institutions,  but  little 
attention  has  been  given  to  internal  control.  All  of  the  City's  public  insti- 
tutions are  especially  deficient  in  an  internal  control  system,  and  much 
study  is  needed  along  this  line.  The  consumption  of  foods  and  materials 
should  be  standardized  in  connection  with  the  institutions,  and  a  reason- 
able ratio  established  for  each  article.  Such  a  study  would  require  a 
great  amount  of  time,  but  would  result  in  marked  economy,  and  would  be  of 
greatest  value  in  formulating  budgets. 

Efficiency  tests  for  the  results  of  both  surgical  and  medical  practice 
should  be  devised,  in  order  that  the  City  may  know  in  what  degree  its 
public  institutions  are  serving  the  purpose  for  which  they  are  supposed 
to  exist.  At  present  there  are  no  such  standards  even  in  connection  with 
private  hospitals,  but  some  of  our  leading  surgeons  and  clinicians  believe 
that  some  standards  of  testing  efficiency  are  feasible  and  desirable. 

A  study  should  be  made  to  determine  what  kind  of  data  is  necessary  on 
which  to  base  a  judgment  as  to  the  need  for  new  hospitals,  and  as  to  their 
advisable  location.  The  projected  rapid  transit  system  which  is  under  con- 
struction will  shift  centers  of  population  and  such  new  centers  must  be 


l8  HOSPITAL  COMMITTEE 

served  with  hospital  accommodations.     How  such  accommodations  may  be 
furnished  should  be  carefully  studied. 

It  is  of  utmost  importance  that  some  department  or  individual  be  en- 
trusted with  the  task  of  seeing  that  the  recommendations  of  this  Report 
are  carried  out.  This  involves  cooperating  with  the  departments  to  bring 
about  certain  internal  administrative  changes  and  reorganizations,  and  the 
drafting  of  bills  and  securing  their  enactment  by  the  State  Legislature,  and 
consultation  with  Federal  authorities  to  the  end  that  the  Federal  law  may  be 
amended  in  certain  particulars  and  departmental  regulations  modified. 

JNIany  things  recommended  in  this  Report  have  been  brought  about  dur- 
ing the  period  of  the  investigation.  From  time  to  time  suggestions  have 
been  made  to  the  departmental  heads,  and  in  quite  a  good  many  instances 
such  suggestions  have  been  acted  on.  Special  reference  should  be  made 
to  the  more  careful  distribution  of  food  in  Metropolitan  Hospital;  the 
painstaking  experiment  in  the  distribution  of  food  in  Bellevue  Hospital, 
resulting  in  marked  reduction  of  the  amount  of  meat  used ;  certain 
changes  in  the  method  of  caring  for  children  in  several  of  the  hospitals. 
A  large  proportion  of  the  lame,  the  halt,  and  the  blind  were  removed  from 
Farm  Colony,  and  instructors  of  industrial  work  were  asked  for  in  the 
budget  of  the  Department  of  Public  Charities  and  an  appropriation  was 
granted  therefor. 

In  connection  with  each  subdivision  of  the  Report  there  are  a  summary 
of  findings,  conclusions,  and  recommendations,  which  in  this  bound  volume 
have  been  brought  forward  as  part  of  the  first  section  of  the  Report.  The 
summaries  of  findings  are  designed  to  set  forth  some  of  the  salient  facts 
only,  and  these  facts  are  stated  so  briefly  that  in  many  cases,  in  order  to 
gain  a  full  understanding,  it  will  be  necessary  to  refer  to  the  body  of  the 
Report  for  an  amplification  of  the  facts.  Nevertheless,  a  fairly  clear  idea 
of  the  scope  and  trend  of  the  Report  can  be  secured  by  reading  the  sum- 
maries of  findings  only.  Some  parts  of  the  Report  are  in  the  nature  of 
recommendations,  and  cannot  readily  be  summarized,  as,  for  instance, 
Suggestions  for  the  Organization  of  an  Out-Patient  Department  and  Pro- 
posed Reorganization  of  the  Medical  Service  in  Bellevue  Hospital. 

In  reaching  conclusions  and  formulating  recommendations  I  have  been 
largely  guided  by  the  counsel  of  a  number  of  our  leading  physicians  and 
educators.  Without  specific  reference,  I  desire  to  express  my  apprecia- 
tion of  their  counsel  and  advice. 

I  desire  to  acknowledge  the  loyal  and  hearty  cooperation  of  my  staff,  with 
special  mention  of  the  heads  of  divisions  of  work: 

Dr.  L.  L.  Williams,  U.  S.  Public  Health  Service. 

Dr.  John  H.  Carroll,  Instructor,  New  York  and  Bellevue  Medical  School. 
H.  B.  Dinwiddle,  formerly  Chief  Investigator  for  Bellevue  and  Allied 
Hospitals. 

Edward  F.  Stevens,  Hospital  Architect,  Boston. 

John  P.  Fox,  Housing  Expert. 

Charles  G.  Armstrong,  Consulting  Engineer. 

R.  H.  Dillingham,  Certified  Public  Accountant. 

Raleigh  Weintrob,  Investigator  of  Sickness  in  the  Homes. 

F.  E.  Brooke,  Investigator  of  Administrative  Problems. 

Nicholas  Hansen,  Investigator  of  Out-Patient  Department. 


SUMMARIES  OF  FINDINGS, 
CONCLUSIONS,  AND  RECOMMENDATIONS 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,   AND   RECOMMENDATIONS 

WITH     REGARD    TO 

ALIENS,   NON-RESIDENTS,   AND    STATE   POOR  IN 
CITY   INSTITUTIONS 

A.  Summary  of  Findings : 

Aliens 

1.  To  determine  the  number,  length  of  stay  in  the  United 
States,  and  physical  condition  of  aliens,  the  records  in  Bellevue  Hos- 
pital for  the  year  1912  were  examined,  and  also  the  records  in  City 
Home,  Blackwell's  Island,  for  a  given  period. 

To  supplement  information  in  the  records,  the  patients  admitted 
to  Bellevue  Hospital  from  May  19  to  June  18,  1913,  were  physically 
examined,  and  were  questioned  as  to  citizenship  and  social  condi- 
tions (page  141).  For  a  like  purpose,  the  friends  or  relatives  of 
inmates  in  City  Home,  Blackwell's  Island,  were  visited  in  connection 
with  about  800  cases. 

The  examination  of  these  patients  and  inmates  revealed  the  fact 
that  many  more  aliens  were  admitted  to  these  institutions  than 
shown  by  the  records,  probably  owing  to  the  fact  that  incorrect 
or  insufficient  information  was  secured  from  the  patient  or  inmate 
on  admission  to  the  institution.  The  following  estimates  as  to  the 
number  of  aliens  cared  for  by  the  City  and  the  cost  of  their  mainte- 
nance are  based  upon  information  obtained  directly  from  the  pa- 
tients and  inmates,  their  relatives  and  friends,  and  from  the  records. 

2.  Of  the  patients  admitted  to  Bellevue  Hospital  during  the 
month  above  indicated,  30.6  per  cent,  acknowledged  that  they  were 
not  citizens  of  the  United  States.  The  aggregate  cost  of  supporting 
these  patients  up  to  September  9,  1913,  was  about  $18,080.  Belle- 
vue Hospital  received  but  $119  from  all  sources  for  the  care  of 
these  aliens.  On  the  basis  of  this  ratio  the  cost  of  maintaining 
aliens  in  Bellevue  Hospital  alone  for  a  year  would  aggregate  about 
$265,777.     (Page  143.) 

Of  the  total  admissions  to  Bellevue,  13.6  per  cent,  were  deport- 
able under  the  Federal  and  State  laws.  These  clearly  deportable 
cases  cost  Bellevue  for  maintenance,  up  to  September  9,  1913, 
$7,500,  with  but  $16.50  received  as  reimbursement.  The  cost  to 
Bellevue  of  maintaining  aliens  removable  under  Federal  and  State 
laws  for  a  year  would  be  about  $1 10,000.  For  the  support  of  aliens 
having  been  in  the  country  less  than  3  years  the  estimated  cost  to 
Bellevue  for  maintenance  would  be  about  $84,000  annually,  and  of 
21 


HOSPITAL   COMMITTEE 

this  amount  about  $47,000  could  be  attributed  to  aliens  deportable 
under  the  State  and  Federal  laws.     (Pages  143  to  146.) 

3.  Of  all  admissions  to  Bellevue,  4  per  cent,  were  aliens  who 
had  conditions  which,  under  the  Federal  Immigration  Law,  made 
their  exclusion  from  this  country  mandatory.  These  mandatory 
cases  in  the  course  of  a  year  may  be  estimated  to  cost  Bellevue 
about  $34,000. 

4.  But  10  per  cent,  of  the  patients  that  were  mandatorily 
excludable  seemed  to  have  entered  the  country  through  oversight  on 
the  part  of  the  examining  physicians  at  Ellis  Island.  Ninety  per 
cent,  of  these  excludable  aliens  were  not  excluded  by  the  examining 
physicians  at  Ellis  Island  probably  because  of  a  lack  of  examining 
physicians,  interpreters,  and  suitable  accommodations  for  the  exam- 
ination of  ahens.     (Page  148.) 

5.  The  cost  to  the  City  of  maintaining  aliens  in  the  almshouses 
is  estimated  to  be  about  $172,000  annually,  according  to  the  findings 
for  the  period  investigated.  This  amount  exceeds  by  $90,000  the 
amount  that  it  would  cost  if  the  aliens  in  the  almshouses  bore  the 
same  ratio  to  the  total  almshouse  population  as  aliens  bear  to  the 
total  population  of  the  City.     (Page  155.) 

6.  Previous  to  1876  the  State  of  New  York  was  in  charge  of 
the  admission  of  immigrants,  and,  from  a  fund  provided  by  a  head 
tax,  agreed  to  pay  for  the  support  of  all  sick  and  pauper  immigrants 
within  a  period  of  5  years  after  landing.  The  Federal  Government 
took  over  the  Immigration  Service  in  1882,  and  thereafter  made 
contracts  with  the  State  of  New  York  for  the  care  of  sick  and  pau- 
per aliens,  which  contracts  were  in  force  until  1891,  when  they  were 
discontinued.  Since  that  time  New  York  City  has  received  a  negligi- 
ble amount  for  such  aliens  from  the  Federal  Government.  Similar 
contracts  were  made  by  the  Federal  Government  with  the  State 
Board  of  Charity  of  Massachusetts,  continuing  in  force  until  191 1. 
(Pages  108  and  112.) 

The  head  tax  which  formerly  was  collected  as  an  insurance  fund 
with  which  to  provide  hospital  or  almshouse  care  for  aliens  is  now 
turned  into  the  Federal  Treasury.  The  head  tax  is  sufficient  to  cover 
the  operating  expenses  of  all  immigration  stations  and  to  leave  in  the 
Federal  Treasury  over  $1,000,000  annually. 

The  United  States  Department  of  Labor,  under  date  of  Decem- 
ber 24,  1913,  notified  officials  of  New  York  City  that,  beginning  with 
January  i,  19 14,  the  Federal  Government  would  not  pay  for  the 
care  of  aliens  in  the  municif)al  institutions  who  had  become  public 
charges  from  causes  existing  prior  to  landing. 

7.  According  to  the  reports  of  the  State  Board  of  Charities  the 
Federal  Government  removes  but  few  aliens  from  the  institutions 
of  New  York  City.  For  the  year  ending  September  30,  1912,  it 
removed  44  aliens,  and  but  7  of  tliese  were  removed  from  Bellevue 
and  Allied  Hospitals.  At  the  same  tftne  688  aliens  were  removed 
through  the  State  Board  of  Charities.     (Page  199.) 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  23 

8.  Previous  to  1906  the  Department  of  Public  Charities,  ac- 
cording to  its  reports,  transferred  deportable  aliens  directly  to  the 
Federal  authorities  at  Ellis  Island.  In  1902  there  were  1,137  aliens 
thus  transferred.  In  1906  the  Commissioner  of  Charities  issued  an 
order  that  aliens  should  be  reported  to  the  State  Board  of  Charities 
for  investigation  and  removal.  Since  that  year  the  number  of  aliens 
removed  has  been  fewer  than  under  the  former  plan.     (Page  49.) 

9.  The  estimated  cost  of  caring  for  aliens  in  the  municipal  hos- 
pitals of  New  York  City  (exclusive  of  the  hospitals  in  the  Health 
Department  and  those  on  Randall's  Island)  is  about  $916,800  an- 
nually. The  cost  of  caring  for  aliens  in  the  almshouses  is  about 
$172,000  annually,  or  an  aggregate  cost  of  over  $1,000,000  annually. 
This  amount  does  not  include  the  cost  to  the  City  of  supporting 
aliens  in  private  institutions.  The  estimated  cost  to  the  City  of 
caring  for  those  patients  in  the  foregoing  hospitals  (excluding  the 
almshouses)  who  have  been  in  this  country  less  than  5  years  is  about 
$386,700  annually. 

Non-Residents  of  New  York  City 

1.  In  1912,  according  to  the  records  of  Bellevue  Hospital,  there 
were  2,431  admissions  of  non-residents  of  New  York  City.  These 
patients  cost  the  City  for  support  not  less  than  $47,600.  The  Hos- 
pital received  as  reimbursement  for  their  support  only  $1,039. 
(Page  125.) 

2.  The  reexamination  of  patients  in  Bellevue  made  by  the 
Committee,  heretofore  referred  to,  made  it  clear  that  the  records  of 
Bellevue  do  not  contain  full  and  accurate  information  with  regard 
to  the  number  of  non-residents  cared  for.  According  to  the  num- 
ber discovered  by  the  Committee,  an  estimated  total  entering 
Bellevue  during  a  year  would  be  in  the  neighborhood  of  5,500, 
and  would  cost  the  Hospital  for  maintenance  at  least  $112,000. 
(Page  151.) 

3.  Of  the  2,431  admissions  of  non-residents  shown  in  the  rec- 
ords, 1,148  were  of  patients  who  walked  to  the  Hospital  and  802 
had  been  in  New  York  State  less  than  60  days.     (Page  127.) 

4.  Of  these  non-residents,  21.8  per  cent,  had  been  in  the  City 
I  day  or  less;  26.4  per  cent.  3  days  or  less;  33.3  per  cent,  i  week 
or  less;  47.7  per  cent,  i  month  or  less.     (Page  139.) 

5.  Judging  by  the  character  of  the  diseases  and  the  length  of 
time  in  the  City,  it  is  strongly  probable  that  fully  67  per  cent,  of 
the  non-residents  had  the  ailments  which  caused  them  to  be  in  Belle- 
vue before  they  came  to  New  York  City.     (Page  131.) 

6.  The  State  Board  of  Charities  is  charged  with  the  duty  of 
removing  non-residents  of  the  State  from  the  public  institutions  of 
this  City.  From  May  19,  1913,  to  June  18,  1913,  the  Committee 
found  322  non-residents  of  New  York  State  in  Bellevue  Hospital. 
Of  these  the  State  Board  of  Charities  removed  7.     (Table  XL.) 


24  HOSPITAL   COMMITTEE 

7.  During  the  month  of  May,  191 1,  Bellevue  Hospital  referred 
3S8  cases  of  aliens  and  non-residents  to  the  State  Board  of  Chari- 
ties. Of  these,  21  were  removed  and  179  were  not  examined. 
(Page  139.) 

8.  A  dependent  person  who  has  not  resided  60  days  in  any 
county  of  the  State  is  classed  as  a  State  Poor  person,  and  the  State 
assumes  the  responsibility  for  the  care  of  such  dependents  and  is 
supposed  to  pay  for  their  support  in  almshouses  designated  by  it  as 
State  Almshouses. 

The  average  number  of  State  Poor  annually  acknowledged  and 
supported  by  the  State  through  the  agency  of  the  State  Board  of 
Charities  for  the  6  years  preceding  1899  was  2,014.  Since  1900  the 
number  acknowledged  and  supported  has  gradually  decreased,  until 
the  average  number  from  1905  to  191 1  was  but  575  annually.  Thus, 
an  increasing  number  of  State  Poor  are  apparently  being  supported 
in  the  institutions  of  New  York  City  without  reimbursement  by  the 
State.  The  City  received  for  such  support  in  1902,  $5,500,  and 
in  1912,  $600.     (Page  157.) 

In  1902  43  per  cent,  of  the  total  amount  paid  by  the  State  Board 
of  Charities  for  the  support  of  State  Poor  was  paid  to  New  York 
City.  In  191 1  New  York  City  received  but  14  per  cent,  of  the 
total  amount  paid  in  the  State  by  the  State  Board  of  Charities. 
(Page    157.) 

B.  Conclusions: 

Aliens 

1.  Many  thousands  of  dependent  aliens  who  are  a  proper 
charge  upon  the  steamship  companies  that  have  brought  them  into 
this  country,  or  upon  the  Federal  Government,  not  only  are  a  heavy 
burden  upon  the  City  of  New  York  for  maintenance  in  public  insti- 
tutions, but  they  also  occupy  beds  to  the  exclusion  of  many  citizens 
of  New  York  City  who  are  in  need  of  custodial  or  medical  care. 

2.  A  careful  physical  examination  of  aliens  in  Bellevue  Hos- 
pital made  by  physicians  employed  by  the  Committee  indicates  that 
a  large  proportion  of  these  aliens  were  afflicted  with  the  ailment 
which  caused  them  to  be  in  Bellevue  before  coming  to  the  United 
States.  In  most  cases  these  ailments  could  have  been  detected  at 
Ellis  Island  had  the  United  States  Public  Health  Service  had  suf- 
ficient inspectors  and  facilities  to  enable  them  to  make  more  search- 
ing examinations. 

3.  The  lack  of  a  sufficient  number  of  medical  inspectors  at 
ElHs  Island  has  resulted  in  an  inadequate  examination  of  alien  sea- 
men, and  many  of  these  seamen  have  become  dependents  in  our 
public  institutions. 

4.  Comparatively  little  relief  has  been  given  the  City  by  the 
removal  of  aliens  from  its  institutions  by  the  United  States  Immi- 
gration Service.  This  is  probably  due  to  the  fact  that  not  enough 
men  are  employed  in  this  Service,  and  that  the  process  of  confirma- 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  25 

tion  and  certification  is  so  involved  as  to  result  in  a  long  delay; 
during  which  period  of  delay  the  expense  of  maintaining  dependents 
under  investigation  falls  upon  New  York  City. 

5.  Formerly  the  United  States  Immigration  Service  recom- 
pensed New  York  City  for  deported  aliens  from  the  time  they  en- 
tered an  institution  to  the  time  they  were  removed.  Under  the 
regulation  now  in  vogue  (previous  to  December  31,  1913)  the  City 
receives  payment  only  from  the  time  that  the  United  States  accepts 
them  as  dependent  aliens,  and  this  acceptance  is  made  only  after  an 
investigation,  which  may  cover  quite  a  lengthy  period.  This  change 
in  the  period  of  payment  has  resulted  in  an  additional  expense  to 
New  York  City. 

6.  Previous  to  1906  the  Department  of  Public  Charities  trans- 
ferred dependent  aliens  direct  to  Ellis  Island.  Since  that  year  it 
has  been  the  regulation  of  the  Department  of  Charities  to  report 
dependent  aliens  to  the  State  Board  of  Charities  for  inquiry  and/ 
action.  As  a  result  of  this  change  fewer  aliens  are  deported,  and 
those  that  are  deported  remain  a  charge  on  New  York  City  a  much 
longer  time.  The  order  of  the  Department  of  Labor  referred  to  in 
paragraph  number  6  of  the  Summary  of  Findings  deprives  New 
York  City  of  the  small  remaining  recompense  mentioned  above. 

7.  The  State  Board  of  Charities  has  not  fully  exercised  the 
function  of  removing  aliens  delegated  to  it  by  law.  It  has,  in  known 
instances,  failed  to  examine  a  substantial  proportion  of  the  aliens 
referred  to  it  for  investigation  for  deportation,  and  has,  in  other 
instances,  removed  only  a  small  proportion  of  cases  that  seemingly 
should  have  been  removed. 

8.  The  burden  of  proof  as  to  whether  or  not  a  dependent  is  an 
alien  and  not  entitled  to  support  rests  upon  the  ofificers  in  charge 
of  the  public  institutions.  That  they  have  not  thus  far  met  this 
responsibility  is  evident  from  the  large  number  of  aliens  found  in 
the  institutions.  The  failure  to  meet  this  responsibility  not  only 
costs  the  City  many  thousands  of  dollars  yearly,  but  reduces  the 
amount  of  accommodation  that  otherwise  would  be  available  for 
citizens  in  need  of  help. 

9.  Although  by  the  Charter  of  the  City  of  New  York  the 
Commissioner  of  Public  Charities  is  directed  to  investigate  the 
legitimacy  of  the  dependence  of  all  applicants  for  admission  to  in- 
stitutions under  his  control,  the  authority  for  the  removal  of  such 
aliens,  non-residents,  and  State  Poor  dependents  is  not  clear,  and 
insufficient  funds  have  been  provided  for  making  investigations  and 
for  the  payment  of  transportation  expenses. 

10.  The  present  power  of  removal  vested  in  the  State  Board 
of  Charities  has  not  afforded  adequate  relief  for  the  City,  nor  does 
it  seem  likely  to  do  so. 


26  HOSPITAL   COMMITTEE 

Non-Rcsidcnts 

I.  Non-Residents  of  New  York  State 

1.  The  facilities  afforded  in  New  York  City,  and  the  freedom 
with  which  non-residents  of  New  York  State  are  admitted  into  its 
municipal  institutions,  have  resulted  in  the  dependence  of  large 
numbers  of  these  non-residents  upon  the  City. 

2.  A  substantial  majority  of  the  non-residents  of  New  York 
State  admitted  to  Bellevue  Hospital  were  aliens  as  well  as  non- 
residents. 

3.  Non-residents  of  New  York  State  occupy  many  beds  in  our 
municipal  institutions  to  the  exclusion  of  needy  citizens. 

4.  The  lack  of  provision  in  the  law  of  this  or  of  adjoining 
states  to  enable  this  State  to  deport  dependent  non-residents  to  the 
state  to  which  they  belong,  makes  it  difficult  for  our  municipal 
institutions  to  discharge,  non-residents  once  they  have  been  ad- 
mitted. 

5.  The  difference  between  the  laws  defining  the  settlement 
necessary  for  maintenance  as  a  poor  person  in  the  State  of  New 
York  and  in  the  adjoining  states  makes  it  possible  for  a  person  who 
is  not  a  resident  of  this  State  to  become  dependent  here  without 
having  a  settlement  in  the  state  from  which  he  came. 

6.  In  the  State  of  Massachusetts  justices  are  empowered  to 
order  the  removal  of  non-residents.  Were  such  a  law  in  force  in 
New  York  State  this  City  would  save  many  thousands  of  dollars 
annually. 

7.  The  power  of  removal  of  non-residents  is  given  to  two  State 
Boards  in  New  York;  namely,  the  State  Board  of  Charities  and 
the  State  Hospital  Commission.  The  State  Board  of  Charities  has 
removed  only  a  small  proportion  of  the  non-residents  from  Bellevue 
Hospital  which  the  records  appear  to  show  might  properly  have 
been  removed.  It  has  removed  comparatively  few  of  the  cases 
referred  to  it  for  removal  by  the  Department  of  Public  Charities. 

II.  Non-Residents  of  New  York  City 

I.  Non-residents  of  the  City,  although  residents  of  the  State, 
have  been  freely  admitted  to  municipal  institutions,  and  have  been 
maintained  there  at  heavy  expense.  In  the  State  of  Massachusetts 
action  may  be  brought  by  the  Poor  Law  officers  in  a  locality  in  which 
a  poor  person  with  settlement  elsewhere  becomes  dependent,  for 
the  recovery  of  the  expense  of  his  relief  from  the  place  of  his  set- 
tlement. In  the  State  of  New  York,  according  to  the  interpreta- 
tion of  the  Supreme  Court,  this  can  be  done  only  when  the  depend- 
ent had  become  a  "poor  person"  before  leaving  the  place  of  his  settle- 
ment. A  municipality  in  New  York  State,  under  the  existing  laws, 
has  not  the  equal  legal  facilities  for  relieving  itself  of  non-residents 
having  a  legal  settlement  within  the  State  that  it  has  of  relieving 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  27 

itself  of  non-residents  not  having  a  legal  settlement  within  the 
State.  The  lack  of  a  clear  and  adequate  provision  touching  these 
matters  in  New  York  State  bears  heavily  on  New  York  City. 

2.  It  is  clear,  since  over  one-half  of  the  non-resident  patients 
of  Bellevue  walked  to  the  door  of  this  institution,  that  regulation 
of  admission  is  lax.  This  is  emphasized  by  the  fact  that  the  length 
of  stay  in  the  City  of  the  majority  of  the  non-residents  of  the  City 
previous  to  admission  to  Bellevue  was  of  short  duration,  a  substan- 
tial proportion  having  been  in  the  City  only  i  day  or  less. 

3.  Since  a  large  majority  of  the  non-resident  United  States 
citizens  admitted  to  Bellevue  Hospital  in  19 12  appear  to  have  con- 
tracted the  ailments  which  caused  their  dependence  before  coming 
to  the  City,  they  could  lay  little  claim  to  the  hospitality  and  care  of 
New  York  City. 

4.  The  Board  of  Trustees  of  Bellevue  and  Allied  Hospitals 
has  made  no  attempt  to  collect  the  expenses  of  non-residents  of  New 
York  City  maintained  in  its  institutions  from  the  places  of  their 
legal  settlement  within  the  State,  and  it  is  questionable  whether  they 
have  authority  to  press  such  claims.  If  a  sum  proportionate  to  that 
collected  by  Boston  City  Hospital  from  Massachusetts  and  from 
counties  and  towns  of  that  State  were  collected  by  Bellevue  Hospital 
for  patients  not  having  a  legal  settlement  in  the  City,  it  would  re- 
ceive annually  not  less  than  $200,000  from  New  York  State  and 
its  subdivisions. 


III.     State  Poor 

1.  The  State  Board  of  Charities  has  reported  from  1902  to 
191 1  as  State  Poor  only  about  one-half  of  the  number  of  cases 
classed  by  the  Department  of  Public  Charities  as  State  Poor  in  its 
Annual  Reports. 

2.  The  State  Board  of  Charities  in  recent  years  has  maintained 
and  reported  annually  a  very  much  smaller  number  of  State  Poor 
cases  throughout  the  State  than  for  many  years  previously.  The 
average  number  of  State  Poor  cases  maintained  annually  is  less  than 
was  maintained  30  years  ago. 

3.  The  payments  by  the  State  Board  of  Charities  to  New  York 
City  for  the  maintenance  of  State  Poor  have  diminished  greatly 
in  the  last  10  years.  Of  the  total  amount  paid  to  the  entire  State, 
the  proportion  paid  by  the  State  Board  of  Charities  to  New  York 
City  for  the  maintenance  of  State  Poor  has  greatly  decreased.  The 
proportion  of  removals  by  the  Board  from  New  York  City  as 
compared  with  the  number  removed  from  the  entire  State  is  only 
about  one-half  what  it  was  10  years  ago. 

4.  The  provision  made  in  the  State  Poor  Law  that  all  State 
Poor  shall  be  maintained  at  State  Almshouses  excludes  those  neces- 
sarily maintained  in  hospitals.  This  provision  burdens  the  City 
without  recompense. 


28  HOSPITAL   COMMITTEE 

C.  Recommendations: 

Means  of  Reducing  the  Burden  upon  the  City  for  the  Care  of  Aliens 
and  Non-Residents. — Immediate,  though  Partial 
I.     Establish  at  Bellevue  a  bureau  to  perform  the   following 
functions : 

(a)  To  have  charge  of  that  portion  of  the  admission  work 
which  deals  with  the  social  condition  and  history  of  applicants. 
A  representative  of  the  bureau  should  attempt  to  secure  from 
each  applicant,  exclusive  of  emergent  cases,  the  facts  pertain- 
ing to  his  nativity;  length  of  residence  in  the  United  States;  in 
New  York  State;  in  New  York  City;  whether  or  not  natural- 
ized ;  and  should  inquire  as  to  facts  relating  to  his  dependence. 

(b)  To  make  inquiry  of  patients  in  the  wards  from  whom 
satisfactory  information  could  not  be  gained  at  the  time  of  ad- 
mission covering  the  foregoing  information. 

(c)  By  means  of  field  investigators,  to  secure  the  informa- 
tion above  indicated  from  friends  or  relatives  when  full  and 
satisfactory  information  cannot  be  secured  from  the  patients. 

(d)  To  collect  from  patients  able  to  pay  for  their  treat- 
ment. 

(e)  To  collect  from  officers  outside  of  New  York  City 
responsible  for  the  care  of  dependents  that  may  have  entered 
Bellevue  and  Allied  Hospitals,  after  the  law  has  been  so 
amended  as  to  make  such  responsibility  clear.  (This  relief 
would  not  be  immediate,  but  might  be  obtained  within  a  year 
if  legislation  could  be  secured  during  the  coming  session  of 
the  Legislature.) 

(f)  To  communicate  with  State  officers  responsible  for  the 
State  Poor  and  removal  of  non-residents,  and  with  Federal 
officers  responsible  for  the  care  and  deportation  of  aliens. 

(g)  To  have  charge  of  all  statistical  records  of  the  hos- 
pitals. 

The  organization  and  method  of  procedure  of  such  bureau  to  be 
as  follows: 

(a)  The  bureau  to  be  in  charge  of  a  high  class  man  versed 
in  social  work  and  social  needs,  and  statistical  methods. 

(b)  The  staff,  in  addition  to  the  chief,  to  consist  of  a  rep- 
resentative at  each  of  the  allied  hospitals;  field  investigators; 
a  statistical  clerk ;  and  a  stenographer. 

(c)  The  representative  at  each  of  the  allied  hospitals  to 
participate  in  the  work  of  admission;  to  make  inquiries  of  the 
patients  in  the  wards;  and  to  transfer  to  the  head  officer  at 
Bellevue  names  of  patients  for  removal  by  the  State  or  Federal 
authorities  and  those  for  field  investigation.  All  field  investi- 
gations to  be  made  by  investigators  from  the  main  office  at 
Bellevue,  and  all  statistical  matter  from  the  allied  hospitals  to 
be  worked  up  at  the  main  office. 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  29 

The  estimated  budget  for  the  above  bureau  is  as  follows : 

1  chief  of  the  investigating  bureau $3,000 

1  stenographer 720 

1  statistical  clerk 900 

5  admitting  officers  @  $1,200 6,000 

4  field  investigators  @  $1,200 4,800 

$15,420 

The  expenditure  of  the  above-indicated  amount  of  money 
should  save  Bellevue  and  Allied  Hospitals  annually  several  times 
the  amount  expended.  It  is  probable  that  such  a  bureau,  aside  from 
excluding  many  non-residents  who  should  not  be  treated  by  the 
City,  and  securing  the  deportation  of  aliens  afflicted  with  sickness 
before  entering  the  country,  would  collect  from  other  states;  from 
New  York  State;  from  subdivisions  of  New  York  State;  from  in- 
dividuals; and  from  the  Federal  Government.  Such  collections 
would  amount  to  many  thousands  of  dollars  annually. 

2.  Aid  in  securing  a  larger  appropriation  for  the  use  of  the 
State  Board  of  Charities ;  to  be  used : 

(a)  for  the  removal  of  non-residents  and  aliens  from  our 
public  institutions ; 

(b)  for  the  support  of  the  State  Poor. 

3.  Reestablish  the  system  formerly  in  operation  of  reporting 
directly  to  the  Federal  authorities  at  Ellis  Island,  instead  of  through 
the  State  Board  of  Charities,  all  aliens  found  to  be  dependents. 

4.  Bring  to  the  attention  of  the  Federal  authorities  at  Wash- 
ington the  need  for  additional  help  and  facilities  at  Ellis  Island,  as 
follows : 

(a)  Additional  examining  physicians  in  the  Public  Health 
Service. 

(b)  Increase  in  facilities  for  the  detection  of  all  organic 
diseases  and  mental  defects,  and  additional  detention  rooms  for 
observation  in  all  classes  of  cases. 

(c)  Interpreters  for  the  medical  service. 

(d)  Additional  inspectors  in  connection  with  the  examina- 
tion of  cases  in  hospitals  and  almshouses  alleged  to  be  deport- 
able aliens. 

Means  of  Reducing  the  Burden  upon  the  City  for  the  Care  of  Aliens 
and  Non-Residents. — Dependent  upon  Legislative  Amendments 

I.  The  officer  of  the  City  who  is,  or  becomes,  Overseer  of  the 
Poor  to  be  given  power  to  investigate  alleged  alien,  non-resident. 
State,  County,  and  Town  Poor  in  all  of  the  institutions  supported 
by  the-  City,  and  City  charges  in  private  institutions.  Also,  power 
to  take  final  action  with  regard  to  such  patients,  and,  after  the 


30 


HOSPITAL   COMMITTEE 

laws  have  been  amended  in  accordance  with  the  following  sugges- 
tions, to  transfer  aliens  to  the  Federal  Government;  to  transport  non- 
resident, State,  County,  and  Town  Poor  to  the  authorities  legally 
responsible  for  their  care;  or  to  collect  for  their  care  in  case  they 
are  dependents  upon  the  City  of  New  York. 

2.  Amend  the  law  so  that  the  State  Poor  shall  include  all 
public  charges  not  having  a  legal  settlement  in  some  subdivision  of 
the  State,  and  make  the  proof  of  residence  rest  upon  the  State  rather 
than  the  locality. 

3.  Amend  the  law  so  that  the  definition  of  County  Poor  shall 
include  any  dependent  having  a  legal  residence  in  a  county  of  the 
State  and  not  having  acquired  a  residence  elsewhere. 

4.  Amend  the  lavi^  so  that  County  or  Town  Poor  will  be  de- 
pendent upon  the  county  or  town  wherein  the  dependent  has  a  legal 
residence. 

5.  Endeavor  to  secure  agreements  on  the  part  of  the  states 
adjoining  New  York  State  to  accept  dependents  who  have  a  legal 
residence  in  any  subdivision  of  such  states  but  who  at  the  time  may 
be  a  dependent  in  New  York  State  or  any  subdivision  of  New  York 
State. 

Endeavor  also  to  secure  a  common  agreement  on  the  part  of 
these  states  as  to  the  length  of  time  in  which  legal  residence  may 
be  secured,  so  far  as  such  residence  relates  to  dependence. 

6.  Endeavor  to  secure  an  amendment  to  the  Federal  law  which 
will  regulate  the  landing  of  seamen  and  provide  for  their  examina- 
tion previous  to  landing. 

7.  Endeavor  to  secure  an  amendment  to  the  Federal  law  which 
will  extend  the  period  within  which  a  dependent  alien  may  be  de- 
ported. It  is  suggested  that  a  period  of  5  years  be  given  considera- 
tion. 

8.  Endeavor  to  secure  a  change  in  the  regulations  of  the 
Department  of  Labor  (which  Department  is  in  charge  of  the  Immi- 
gration Service),  so  that  the  City  may  receive  compensation  for  the 
support  of  dependent  aliens  from  the  time  when  they  become  depen- 
dents to  the  time  of  transfer  to  the  Federal  authorities. 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,   AND   RECOMMENDATIONS 

WITH  REGARD  TO 

ADMISSIONS  TO  CITY  HOMES  (ALMSHOUSES) 

A.  Summary  of  Findings : 

1.  All  admissions  to  City  Homes  (almshouses)  are  supposed 
to  be  made  through  Bureaus  of  Dependent  Adults  located  in  the 
different  boroughs.     (Page  249.) 

2.  Of  the  admissions  to  the  City  Home,  Brooklyn,  in  191 1,  29.8 
per  cent,  were  made  on  transfer  slips  bearing  the  signature  of 
the  Superintendent  of  Kings  County  Hospital.  There  is  no  record 
to  indicate  that  these  transfers  from  the  Hospital  were  subsequently 
confirmed  by  any  other  officer.     (Page  271.) 

3.  The  authorizations  for  admissions  found  on  file  at  the 
Brooklyn  Home  for  the  year  191 1  were  241  less  than  the  number 
of  admissions  ofiiicially  published  in  the  City  Record.     (Page  270.) 

4.  Such  admissions  as  were  made  from  the  Bureau  of  De- 
pendent Adults  in  Brooklyn  were  passed  upon  by  a  clerk  in  the 
Bureau,  and  the  admission  permits  were  signed  by  no  other  officer 
than  the  clerk.     (Page  271.) 

5.  Some  admissions  were  made  to  each  of  the  almshouses  with- 
out any  authorization  on  record  in  the  almshouses  or  Bureaus  of 
Dependent  Adults.     (Page  249.) 

6.  At  the  time  of  the  inquiry  of  the  Committee  no  centralized 
record  existed  in  the  Bureau  of  Dependent  Adults,  Manhattan, 
which  would  enable  the  Bureau  to  ascertain  whether  an  applicant 
had  at  any  previous  time  been  an  inmate  of  any  one  of  the  City 
institutions.  Since  the  examination,  and  through  the  cooperation 
of  the  Commissioners  of  Accounts,  a  centralized  system  has  been 
installed.     (Page  259.) 

7.  The  addresses  of  dependents  and  their  relatives  and  friends, 
to  be  communicated  with  in  case  of  necessity,  in  a  large  proportion 
of  the  cases  examined  were  lacking,  out  of  date,  indefinite,  or  in- 
correct.    (Page  252.) 

8.  The  Examiners  of  Charitable  Institutions  connected  with 
the  Manhattan  Bureau  of  Dependent  Adults  investigated  less  than 
20  per  cent,  of  the  admissions  to  the  Manhattan  Home  for  the 
month  of  May,  19 12.  There  is  no  evidence  to  indicate  that  any 
of  the  cases  admitted  to  the  Home  in  Brooklyn  vi^ere  examined  by 
the  Examiners  of  Charitable  Institutions  of  the  Brooklyn  Bureau. 
(Page  255.) 

31 


32  HOSPITAL   COMMITTEE 

9.  The  Bureaus  of  Dependent  Adults  in  Manhattan  and  Brook- 
lyn issued  orders  that  no  dependent  having  been  sent  to  Farm  Col- 
ony, or  having  refused  to  go  there,  should  be  readmitted  to  the 
City  Homes  in  Manhattan  or  Brooklyn.     (Pages  250  and  275.) 

Of  554  dependents  sent  from  the  Manhattan  Home  to  Farm  Col- 
ony, 23  failed  to  arrive:  of  those  arriving,  240  deserted;  of  the  de- 
serters, 103  were  readmitted  to  the  City  Home,  Manhattan;  of  those 
readmitted,  but  17  were  returned  to  Farm  Colony;  of  those  returned 
to  the  Colony,  10  deserted;  and  of  the  10,  4  were  again  received  in 
the  City  Home.  The  same  condition  of  desertion  and  readmission 
existed  in  connection  with  the  City  Home  in  Brookljm.    (Page  258.) 

B.  Conclusions: 

1.  Heretofore  in  the  Department  of  Public  Charities,  owing  to 
the  absence  of  a  centralized  record,  it  has  been  impossible  to  iden- 
tify an  applying  dependent  who  at  some  previous  time  had  been 
admitted  through  one  of  the  Bureaus.  Lacking  such  a  record  it  has 
been  possible  for  applicants  who  may  have  been  rejected  by  one 
Bureau  to  make  application  at  another  Bureau  and  be  admitted,  or 
for  applicants  who  had  deserted  from  Farm  Colony  to  secure  read- 
mission  through  the  Bureau  in  Manhattan  or  in  Brooklyn.  As  a 
result  of  its  defective  record  system  the  Department  of  Public 
Charities  has  been  receiving  and  caring  for  many  inmates  who  were 
not  legitimately  dependent  upon  the  City. 

2.  Owing  to  the  lack  of  sufficient  correlation  between  the 
Bureaus  and  other  branches  of  the  Department,  and  non-enforce- 
ment of  its  own  regulations,  dependents  have  been  admitted  by  the 
Department  of  Charities  through  other  than  the  regular  channels, 
and  without  sufficient  scrutiny  and  examination. 

3.  Owing  to  an  insufficient  number  of  field  inspectors,  failure 
to  use  the  information  on  its  own  records,  and  failure  to  make  thor- 
ough investigations,  the  Department  of  Charities  has  received,  re- 
tained, and  cared  for  a  large  number  of  aliens,  non-residents,  and 
persons  whose  support  could  have  been  borne  by  the  localities  of 
their  legal  settlement,  by  their  relatives,  or  by  their  own  resources. 
The  lack  of  inspectors,  and  the  failure  to  be  guided  by  the  informa- 
tion on  the  records  and  to  require  thorough  investigations,  have  cost 
the  City  many  thousands  of  dollars  annually. 

4.  Discipline  at  Farm  Colony  has  been  made  exceedingly  diffi- 
cult because  of  the  fact  that  deserters  from  the  Colony  and  insubor- 
dinate inmates  who  have  been  expelled  have  been  freely  permitted 
to  reenter  the  Homes  in  Manhattan  and  Brooklyn. 

5.  The  Department  of  Charities  has  not  kept  full  history  rec- 
ords of  all  inmates  in  the  Brooklyn  Home,  as  required  by  law.  The 
lack  of  such  records  makes  it  difficult  to  determine  the  character  of 
inmates  in  the  Homes  at  any  given  time. 

6.  The  records,  especially  in  the  Brooklyn  Home,  were  so  in- 
complete and  fragmentary  that  the  institution  did  not  and  could  not 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  33 

know  on  any  particular  day  what  inmates  were  in  the  institution. 
Such  confusion  in  records  seems  unwarranted. 

7.  The  records  of  the  addresses  of  inmates  and  friends  of  in- 
mates were  not  kept  up  to  date.    As  a  result,  it  would  be  easily  possi-  ' 
ble  for  an  inmate  who  had  died  to  be  buried  in  the  Potter's  Field 
without  notification  reaching  the  friends  of  such  inmate. 

8.  When  the  City  purchased  the  land  adjoining  Farm  Colony 
it  was  with  the  purpose  and  intent  that  Farm  Colony  should  care  for 
and  utilize  the  work  of  the  relatively  able-bodied  dependents.  The 
transferring  in  large  numbers  of  the  crippled  and  decrepit  inmates 
to  Farm  Colony  has,  in  a  large  degree,  complicated  the  problem  of 
operating  the  farm. 

9.  Voluntary  charitable  associations  naturally  possess  records 
of  many  of  the  dependents  in  the  City.  The  City  is  free  to  consult 
this  information,  and  much  labor  and  expense  would  be  saved  if  the 
Department  of  Charities  would  avail  itself  of  the  information  thus 
collected  by  private  organizations.  ^  ^ 

10.  Many  private  social  agencies  aim  to  do  constructive  and 
preventive  work  by  restoring  dependents  to  normal  family  and  so-  \  V 
cial  relations ;  in  handling  the  adult  poor  the  Department  of  Chari-  i 
ties  has  not  sought  the  cooperation  of  these  agencies  in  this  work 

of  rehabilitation. 

C.  Recommendations: 

1.  The  City  should  supply  the  Department  of  Charities  with 
sufficient  investigators  to  enable  it  to  fully  examine  the  family  cir- 
cumstances and  legal  settlement  of  every  applicant  for  admission  to 
the  City  Homes. 

2.  The  Bureaus  of  Dependent  Adults  should  use  all  pertinent 
information  upon  the  departmental  records,  and  require  thorough 
investigations  to  be  made  by  the  Examiners  of  Charitable  Institu- 
tions. 

3.  The  records  of  inmates  should  be  kept  with  such  fullness 
and  accuracy  that  each  institution  would  know  at  all  times  every 
inmate  being  cared  for,  the  cause  of  his  dependence,  and  the  record 
of  his  previous  economic  condition. 

4.  No  transfers  should  be  made  from  the  Municipal  Lodging 
House  or  City  Homes  without  a  full  knowledge  on  the  part  of  the 
Commissioner  of  Public  Charities  of  the  physical  condition  of  each 
inmate  proposed  to  be  so  transferred. 

5.  The  regulation  should  be  strictly  enforced  that  an  inmate 
once  transferred  to  Farm  Colony  should  not  be  readmitted  to  the 
Manhattan  or  Brooklyn  Home  without  the  consent  of  the  Commis- 
sioner of  Public  Charities. 

6.  The  crippled  and  decrepit  should  be  removed  from  Farm' 
Colony,  and  hereafter  only  the  relatively  able-bodied  transferred  to 
that  institution.  The  number,  size,  and  character  of  buildings  at 
Farm  Colony  should  be  adapted  to  this  class  of  inmates. 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,  AND   RECOMMENDATIONS 

WITH   REGARD  TO 

CLINICAL  RECORDS  IN  BELLEVUE  HOSPITAL 

A.  Summary  of  Findings: 

1.  A  large  number  of  the  clinical  records  in  Bellevue  Hospital 
were  examined  by  Dr.  L.  L.  Williams  on  behalf  of  the  Committee, 
and  135  of  the  records  were  reported  in  detail.  Of  this  number,  57 
per  cent,  were  considered  good  by  Dr.  Williams ;  30  per  cent,  were 
incomplete;  and  13  per  cent,  were  poor.     (Page  352.) 

2.  The  character  of  the  records  differs  materially  in  the  differ- 
ent divisions  in  Bellevue.  One  division  had  but  3  per  cent,  of  poor 
histories,  whereas  another  division  had  36.5  per  cent,  of  incom- 
plete histories,  and  27  per  cent,  of  poor  histories.     (Page  352.) 

3.  The  following  cases  are  an  illustration  of  some  of  the  poor 
records  kept: 

Case  123.     Abscess  of  Kidney. 

Admitted  Aug.  12,  19 12. 

Discharged  Oct.  5,  1912. 

Record  of  admission,  physical  examination,  and  operation,  suf- 
ficient. X-ray  record.  Remainder  of  record  by  nurse.  Result 
stated  in  caption  only.  Post-operative  course  can  only  be  inferred 
from  nurse's  notes  of  "dressings  changed,  etc." 

Case  1234.    Lobar  pneumonia;  suppurative  pleurisy;  empyema;  sep- 
ticaemia. 

Admitted  Nov.  27,  1912. 
Died  Dec.  3,  1912. 
Record   of  admission,   physical  examination,   and  laboratory 

examination,  good.     Remainder  of  record  by  nurse.     There  is  no 

mention  in  the  body  of  the  report  of  the  complication  noted  in  the 

caption;  viz.,  empyema. 

A  detailed  presentation  of  the  records  examined  will  be  found 

on  pages  352  to  357. 

B.  Conclusions: 

1.  Some  of  the  divisions  in  Bellevue  Hospital  keep  reasonably 
satisfactory  clinical  records.    One  division  has  very  poor  records. 

2.  It  was  not  determined  whether  the  defects  in  the  records 
were  due  to  inefficient  internes,  or  to  the  lack  of  supervision  on  the 
part  of  the  attending  physicians,  or  to  both. 

35 


36  HOSPITAL  COMMITTEE 

3.  It  is  impossible,  without  full  and  accurate  clinical  histories, 
to  give  satisfactory  treatment  to  patients  who  are  attended  by  differ- 
ent physicians  on  different  days,  or  in  different  periods,  or  who  are 
discharged  and  subsequently  return  to  Bellevue. 

C.  Reconunendations : 

1.  Such  supervision  of  the  medical  records  should  be  estab- 
lished as  to  insure  a  complete  and  accurate  record  of  the  character 
and  progress  of  each  case. 

2.  When  a  patient  is  transferred  from  another  hospital  to 
Bellevue  and  from  Bellevue  to  another  hospital  a  copy  of  the  medical 
record  should  accompany  the  case. 

3.  When  the  autopsy  findings  are  made  in  case  of  death,  cor- 
rections in  the  medical  record  should  be  made  in  such  a  manner  as 
to  indicate  on  the  record  that  the  corrected  diagnosis  is  the  autopsy 
finding,  and  the  original  diagnosis  should  be  allowed  to  stand  as  a 
basis  of  comparison. 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,    AND    RECOMMENDATIONS 

WITH    REGARD   TO 

AUTOPSY  FINDINGS  IN  BELLEVUE  HOSPITAL  COMPARED 
WITH  CLINICAL  DIAGNOSES. 


A.  Summary  of  Findings: 

1.  Bellevue  Hospital  performs  autopsies  on  about  lo  per  cent, 
of  those  dying  in  the  Hospital.  The  University  College  Hospital,  in 
London,  performs  autopsies  on  84  per  cent. ;  Allgemeines  Krank- 
enhaus,  in  Vienna,  on  99.9  per  cent. ;  and  most  of  the  German  hos- 
pitals on  over  90  per  cent,  of  those  dying  in  the  institutions. 

The  number  of  autopsies  performed  on  unclaimed  dead  bodies 
in  Bellevue  has  gradually  decreased,  until  practically  none  are  per- 
formed at  the  present  time.  In  1909,  266  were  performed;  in  1912 
only  12  were  performed.     (Page  362.) 

2.  This  decrease  and  practical  elimination  of  autopsies  on  the 
unclaimed  dead  in  Bellevue  are  due  to  an  order  issued  by  the  Com- 
missioner of  Charities  on  April  15,  1910,  prohibiting  Bellevue  from 
performing  autopsies  thereafter  on  the  bodies  of  the  unclaimed 
dead.  This  order  was  based  upon  a  report  of  a  committee,  which 
held  that  the  law  prohibited  such  autopsies.  A  minority  report  of 
this  committee  held  that,  though  the  law  provided  that  unclaimed 
bodies  should  be  turned  over  to  medical  colleges,  autopsies  might  be 
performed  upon  such  bodies  previous  to  such  delivery.     (Page  363.) 

3.  The  medical  colleges  claim  that  they  need  more  than  1,000 
bodies  yearly  for  the  purpose  of  teaching  anatomy.  According  to 
the  practice  of  leading  medical  colleges  in  the  United  States  about 
400  bodies  should  be  sufficient  for  teaching  purposes  in  the  medical 
colleges,  including  post-graduate,  of  New  York  City.     (Page  364.) 

4.  The  autopsy  findings  in  Bellevue  for  the  year  19 12  were 
compared  by  Dr.  Horst  Oertel  with  the  ante-mortem  or  clinical  diag- 
noses made  by  the  physicians.  His  report  has  been  summarized  as 
follows : 

37 


38  HOSPITAL  COMMITTEE 


I.     Clinical  diagnoses  confirmed 87  22.4% 

II.    Clinical  diagnoses  correct  but  autopsies  disclosed  additional  important 

lesions 116  29 . 9  % 

III.  Clinical  diagnoses  partly  correct  but  other  important   lesions  that 

had  contributed  to  the  diagnosed  lesions  were  found 54  13.9% 

IV.  CUnical  diagnoses  not  confirmed 107  27.6% 

V.     No  clinical  diagnoses  in  death  records 24  6.2% 

388  100.0% 


The  diagnoses  seem  to  have  been  incorrect  in  47.7  per  cent,  of 
the  cases.     (Pages  365  and  366.) 

B.  Conclusions: 

1.  The  percentage  of  autopsies  performed  in  Bellevue  and  in 
most  of  the  large  hospitals  in  the  United  States  is  very  small  as 
compared  with  the  percentage  of  autopsies  performed  in  European 
hospitals,  and  it  is  very  largely  because  of  this  fact  that  medical 
knowledge  advances  more  rapidly  in  Europe  than  in  the  United 
States. 

2.  The  very  strict  interpretation  of  the  law  governing  autop- 
sies made  by  the  Commissioner  of  Charities  has  deprived  Bellevue 
of  much  needed  material,  and  has  surrendered  to  the  medical  col- 
leges an  additional  amount  of  material  which  seems  not  to  have 
been  needed. 

3.  The  large  percentage  of  incorrect  clinical  or  ante-mortem 
diagnoses  in  Bellevue  is  partly  due  to  the  lack  of  medical  knowledge 
among  our  better  class  of  practitioners,  and  partly  to  hasty  and 
insufficient  examinations.  Too  much  reliance  upon  inexperienced 
house  physicians  and  internes  also  accounts  for  a  portion  of  these 
errors. 

4.  A  reasonable  and  satisfactory  number  of  autopsies  can  be 
provided  in  our  public  hospitals  only  by  a  change  in  the  law  govern- 
ing autopsies. 

C.  Recommendations: 

I.  It  is  recommended  that  the  law  governing  autopsies  be 
amended  so  as  to  enable  the  hospitals  to  perfonn  a  much  larger 
percentage  of  autopsies  than  at  present.  Details  of  these  recom- 
mendations will  be  found  on  pages  367  and  368. 


SUMMARY  OF   FINDINGS, 
CONCLUSIONS,    AND    RECOMMENDATIONS 

WITH    REGARD   TO 

DISTRIBUTION  OF  WARD   SPACE  IN 
BELLEVUE  HOSPITAL 

A.  Summary  of  Findings: 

1.  The  number  of  vacant  beds  in  a  service  necessary  to  pro- 
vide for  fltictuations,  as  established  by  Dr.  L.  L.  Williams,  is  about 
12  per  cent,  of  the  total  number  of  beds  in  the  service.     (Page  372.) 

2.  During  the  fourth  quarter  of  1912  the  male  wards  of  the 
Medical  Service  in  Bellevue  had  25.1  per  cent,  of  beds  vacant;  the 
female  wards  20.3  per  cent. ;  the  Genito-urinary  Service  27.8  per 
cent. ;  the  female  Surgical  Service  14.4  per  cent. 

On  the  other  hand  the  male  wards  of  the  Surgical  Service  were 
somewhat  overcrowded,  having  had  but  4.1  per  cent,  of  vacancies. 
(Page  371.) 

3.  Although  the  male  Medical  Service  had  on  an  average  a 
marked  excess  of  beds,  in  certain  divisions  the  beds  were  over- 
crowded. 

In  December,  in  the  First  Division  48.3  per  cent,  of  the  beds 
were  vacant;  whereas,  during  the  same  month,  in  the  Third  Di- 
vision the  vacancies  amounted  to  but  9.  i  per  cent.  During  the  same 
month,  in  the  female  wards  the  First  Division  had  36.6  per  cent, 
of  beds  vacant;  whereas  the  Third  Division  had  but  6.8  per  cent. 
This  high  percentage  of  vacant  beds  in  the  First  Division  as  con- 
trasted with  the  Third  Division  was  noticeable  during  the  3  months 
of  the  quarter.     (Pages  374  and  375.) 

4.  In  the  female  wards  of  the  Surgical  Service  the  Third  Di- 
vision showed  an  average  vacancy  of  beds  of  24.3  per  cent,  during 
the  quarter;  whereas  the  Fourth  Division  had  an  average  vacancy  of 
but  6.9  per  cent.     (Page  376.) 

5.  In  the  Children's  Surgical  Services  the  average  percentage 
of  patients  in  excess  of  beds  in  the  Second  Division  during  the 
quarter  was  21.7  per  cent.;  whereas  the  First  Division  had  1.7  per 
cent,  of  beds  vacant,  and  the  Fourth  Division  4.4  per  cent.,  and  the 
Third  Division  11. 6  per  cent.     (Page  377.) 

6.  In  the  male  Medical  Service,  including  the  four  divisions, 
25.1  per  cent,  of  the  beds  were  vacant;  whereas,  at  the  same  time, 
in  the  Surgical  Service,  taken  as  a  whole,  the  vacancies  amounted 
to  but  4.1  per  cent.     (Pages  371,  374,  and  376.) 

39 


40  HOSPITAL   COMMITTEE 

B.  Conclusions: 

1.  There  was  a  marked  excess  of  beds  in  the  Medical  Service 
in  Bellevue  Hospital  during  the  last  quarter  of  1912;  whereas,  at 
the  same  time,  the  wards  of  the  Surgical  Service  were  overcrowded. 

2.  It  is  very  apparent  that  there  may  be  many  vacant  beds  in 
one  division  while  at  the  same  time  there  will  be  serious  over- 
crowding in  another  division. 

3.  The  system  of  assigning  patients  in  rotation  to  the  four  di- 
visions evidently  operates  in  such  a  manner  as  to  overcrowd  the 
beds  in  some  divisions  and  to  leave  vacant  a  large  percentage  of 
beds  in  other  divisions. 

4.  There  is  apparently  no  attempt  to  transfer  surgical  cases 
from  overcrowded  wards  to  the  vacant  beds  in  the  medical  wards. 
Such  transfer  of  patients  takes  place  in  many  hospitals,  and 
operates  successfully. 

5.  No  arrangement  is  made  to  transfer  patients  from  the 
wards  of  a  division  which  may  be  overcrowded  to  the  wards  of 
another  division  which  may  have  an  ample  number  of  vacant  beds. 

C.  Recommendations: 

1.  The  distribution  of  patients  should  be  so  regulated,  irre- 
spective of  divisions,  as  to  more  evenly  distribute  the  patients 
throughout  the  hospital. 

2.  Inasmuch  as  some  very  successful  hospitals  transfer  surgi- 
cal patients  to  medical  wards  when  the  surgical  wards  are  over- 
crowded and  the  medical  wards  have  vacant  beds  it  would  seem 
feasible  for  Bellevue  to  adopt  the  same  policy. 

3.  If  patients  were  distributed  to  the  different  divisions  in 
proportion  to  the  number  of  beds  assigned  to  those  divisions,  it 
would  lessen  the  tendency  on  the  part  of  any  division  to  discharge 
prematurely  uninteresting  patients  in  order  that  vacancies  might 
be  made  for  the  reception  of  more  interesting  cases.  It  would  seem 
advisable  and  feasible  to  adopt  some  such  method  of  distribution. 


ARGUMENTS  IN  SUPPORT  OF  RECOMMENDATIONS 

It  is  advantageous  to  the  Hospital  to  have  the  medical  colleges  in  charge 
of  the  medical  service.  The  welfare  of  the  patients,  however,  should  be 
considered  paramount  to  the  interest  of  the  medical  schools,  and  it  is  not 
unreasonable  to  expect  the  medical  schools  to  keep  patients  in  their  services 
a  reasonable  length  of  time,  irrespective  of  whether  such  patients  are  or 
are  not  interesting  cases.  Unless  the  colleges  are  expected  and  required 
to  keep  patients  as  long  as  the  Hospital  authorities  deem  advisable  and 
necessary,  cases  will  continue  to  be  discharged  prematurely,  and  different 
wards  will  show  varying  percentages  of  vacant  beds  or  of  congestion. 

It  is,  of  course,  desirable  to  keep  all  surgical  patients  together,  but 
when  the  surgical  wards  are  overcrowded  it  is  much  better  to  transfer 
surgical  patients  to  medical  wards  than  to  discharge  such  patients  prema- 
turely. The  Trustees  should  have  full  control  of  the  distribution  and  as- 
signment of  patients,  and  it  should  be  considered  no  injustice  to  any  one 
medical  school  to  expect  it  to  transfer  patients  to  another  division  if  the 
division  to  which  such  transfer  should  be  made  has  vacant  beds  and  its  own 
division  is  overcrowded. 

If  the  principle  that  the  interest  of  the  patients  is  paramount  to  that  of 
the  medical  schools  be  adopted  and  acted  upon,  methods  can  readily  be 
devised  which  will  more  equally  distribute  the  patients  in  the  Hospital, 
thereby  reducing  congestion  at  certain  places.  This  policy  also  would  re- 
sult either  in  retaining  patients  a  longer  time  than  they  had  previously 
been  retained  in  the  Hospital,  or,  if  they  are  to  be  discharged  as  rapidly  as 
heretofore,  it  would  enable  the  Hospital,  with  a  given  number  of  beds,  to 
care  for  many  more  patients  than  it  has  been  caring  for. 


41 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,   AND   RECOMMENDATIONS 

WITH    REGARD   TO 

TRANSFER  OF  PATIENTS  TO  AND  FROM  BELLEVUE 

HOSPITAL  AND  TO  AND   FROM  KINGS 

COUNTY  HOSPITAL 

October,  November,  and  December,  191 1. 

A.  Siunmary  of  Findings: 

Bellevue  Hospital 

1.  During  the  three  months  October,  November,  and  Decem- 
ber, 191 1,  1,597  patients  were  transferred  to  Bellevue  Hospital  by 
ambulances  of  other  hospitals.  Of  this  total  number  about  10  per 
cent.  died.  Although  the  death  rate  of  these  patients  was  10  per 
cent.,  17.7  per  cent,  of  the  patients  transferred  by  Flower  Hospital 
ambulances  died.     (Page  385.) 

2.  Of  the  transfers  to  Bellevue,  44  per  cent,  were  alcoholics, 
insane,  or  tuberculous;  24  per  cent,  medical;  22  per  cent,  surgical; 
9  per  cent,  miscellaneous.     (Page  385.) 

3.  Of  the  total  number  of  patients  transferred  to  Bellevue,  52 
per  cent,  remained  less  than  4  days.     (Page  385.) 

4.  Of  the  total  number  transferred  to  Bellevue,  167  died. 
Of  this  number,  16  died  on  the  day  on  which  they  reached  Bellevue, 
and  76  others,  or  46  per  cent.,  within  4  days.     (Page  386.) 

5.  Of  the  total  number  (1,723)  transferred  from  Bellevue, 
863,  or  about  50  per  cent,  of  the  patients  transferred,  had  remained 
an  average  of  less  than  4  days  in  Bellevue.  Of  this  number,  107 
were  transferred  within  24  hours.     (Page  386.) 

6.  Exclusive  of  tuberculosis,  about  40  per  cent,  of  the  patients 
transferred  to  Blackwell's  Island  had  remained  in  Bellevue  less  than 
4  days.     (Page  386.) 

7.  Of  the  tuberculous  patients  transferred  from  Bellevue,  65 
per  cent,  had  remained  in  Bellevue  4  days  or  less.     (Page  386.) 

43 


44  HOSPITAL   COMMITTEE 

Kings  County  Hospital 

1.  During  the  three  months  mentioned  172  patients  were 
transferred  from  other  hospitals  to  Kings  County  Hospital,  as  com- 
pared with  1,597  transferred  to  Bellevue  from  other  hospitals.  Of 
this  number  2y  per  cent,  died,  as  compared  with  10  per  cent,  in 
Bellevue.     (Page  388.) 

2.  Of  the  total  number  of  patients  transferred  to  Kings 
County  Hospital,  42  per  cent,  remained  less  than  4  days,  as  com- 
pared with  52  per  cent,  for  the  same  period  in  Bellevue.  (Page 
389.) 

3.  Of  the  47  that  died  in  Kings  County  Hospital,  4  had  been 
in  the  Hospital  but  i  day;  6  died  within  48  hours;  and  10  others 
within  4  days.  In  other  words,  42  per  cent,  of  the  deaths  occurred 
within  4  days  from  the  time  of  reaching  the  Hospital,  as  compared 
with  28  per  cent,  dying  within  the  same  period  in  Bellevue.  (Page 
389.) 

4.  Of  the  total  number  (193)  of  patients  transferred  from 
Kings  County  Hospital  to  City  Home,  Brooklyn,  51  were  diagnosed 
as  "non  curata,"  which  term  is  interpreted  by  the  Hospital  as  mean- 
ing that  the  patient  was  not  sick.  Nevertheless,  3  of  these  remained 
from  5  to  9  days,  and  2  remained  over  10  days  in  the  Hospital  be- 
fore being  transferred  to  the  Home.     (Page  389.) 

5.  Of  59  tuberculosis  cases  transferred  from  Kings  County 
Hospital  to  Metropolitan  Hospital,  30  had  remained  in  Kings 
County  Hospital  more  than  10  days,  and  17  had  remained  from 
5  to  9  days.     (Page  399.) 


B.  Conclusions: 

Bellevue  Hospital 

1.  Flower  Hospital  has  carried  many  patients  in  its  ambu- 
lances to  Bellevue  Hospital  when  practically  at  the  point  of  death. 

2.  The  fact  that  52  per  cent,  of  the  patients  transferred  to 
Bellevue  from  other  hospitals  remained  in  Bellevue  less  than  4  days 
indicates  that,  in  a  large  measure,  Bellevue  is  but  a  "way  station" 
between  private  hospitals  and  some  ultimate  destination  of  the 
patients. 

3.  That  18  patients  brought  to  Bellevue  in  private  ambulances 
died  on  the  day  of  arrival,  indicates  a  marked  tendency  on  the  part 
of  private  hospitals  to  carry  dying  patients  to  Bellevue  rather  than 
to  their  own  hospitals. 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  45 

Kings  County  Hospital 

1.  The  private  hospitals  in  Brooklyn  are  evidently  more  prone 
even  than  some  of  the  private  hospitals  in  Manhattan  to  transfer 
patients  at  the  point  of  death  to  Kings  County  Hospital. 

2.  The  large  number  of  "non  curata"  cases  transferred  from 
Kings  County  Hospital  to  the  City  Home  indicates  that  the  Hos- 
pital, in  quite  a  measure,  is  a  receiving  department  for  the  Home. 
Such  admissions  are  supposed  to  take  place  through  the  Bureau  of 
Dependent  Adults  in  Brooklyn. 

3.  Kings  County  Hospital  is  not  prepared  to  take  care  of 
cases  of  tuberculosis.  The  Hospital  does  not  seem  warranted  in  re- 
taining tuberculous  patients  the  length  of  time  which  the  foregoing 
data  indicate  they  have  stayed. 


C.  Recommendations: 

1.  Section  i  of  Chapter  748  of  the  Laws  of  1907  provides  that 
no  hospital  shall  transfer  a  patient  near  the  point  of  death  except 
for  good  cause,  which  cause  shall  be  set  forth  in  a  certificate  signed 
by  the  attending  physician  or  surgeon,  or,  in  their  absence  from  the 
hospital,  by  the  senior  member  of  the  house  staff.  A  penalty  of 
$100  is  provided  for  failure  to  comply  with  this  Act.  The  Act,  how- 
ever, does  not  forbid  the  ambulance  of  a  private  hospital  to  carry  a 
patient  in  a  dying  condition  from  a  residence  or  the  street  to  Belle- 
vue  rather  than  to  the  hospital  which  operates  the  ambulance.  Such 
a  regulation  could  appropriately  be  made  by  the  Ambulance  Board, 
and  reports  could  be  made  by  Bellevue  with  regard  to  its  effective- 
ness. It  seems  highly  advisable  that  a  patient  in  a  dying  condition 
should  be  transferred  to  the  nearest  hospital,  which,  in  most  cases, 
would  be  the  hospital  operating  the  ambulance.  This  matter  could 
probably  be  regulated,  either  by  the  Ambulance  Board  or  by  Belle- 
vue, without  additional  legislation. 

2.  So  far  as  possible,  Bellevue  Hospital  should  be  relieved  of 
the  necessity  of  receiving  a  large  number  of  patients  from  private 
hospitals  who  are  destined  to  be  sent  within  a  few  hours  to  the 
hospitals  of  the  Department  of  Charities.  These  patients  occupy 
many  beds  and  quite  a  portion  of  the  time  of  the  help  in  Bellevue. 
So  far  as  possible,  these  patients  should  be  transferred  direct  from 
the  private  hospitals  to  the  Department  of  Charities,  or  else  they 
should  be  placed  in  a  receiving  ward  in  Bellevue  provided  for  this 
purpose,  and  which  would  not  require  the  clerical  and  other  work 
necessary  to  admit  them  into  Bellevue. 

3.  Inasmuch  as  Bellevue  is  not  supposed  to  care  for  tubercu- 
lous patients,  it  seems  advisable  that  patients  known  to  have  tubercu- 


46  HOSPITAL   COMMITTEE 

losis  should  not  be  received  at  Bellevue,  but  that  they  should  be 
transferred  at  once  either  to  the  hospitals  of  the  Department  of 
Charities  or  the  Department  of  Health. 

4.  The '  same  statement  about  the  reception  of  tuberculous 
patients  by  Bellevue  may  be  made  with  regard  to  Kings  County 
Hospital. 

5.  The  admission,  discharge,  and  transfer  of  patients  involve 
much  clerical  and  other  labor  on  the  part  of  the  hospitals.  So  far 
as  possible,  immediately  after  diagnosis,  patients  should  be  assigned 
and  delivered  to  the  hospital  which  is  to  care  for  them  throughout 
their  sickness. 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,    AND    RECOMMENDATIONS 

WITH    REGARD   TO 

THE  MORGUE  SERVICE 

A.  Summary  of  Findings: 

1.  The  morgue  service  throughout  the  City  of  New  York  is 
conducted  by  the  Commissioner  of  Public  Charities.     (Page  403.) 

2.  The  morgue  located  on  the  Bellevue  grounds  received  1 1,697 
bodies  during  191 1.  It  is  inadequate,  both  in  size  and  facilities. 
A  new  morgue,  ample  in  capacity  and  splendidly  equipped,  has  been 
constructed  in  connection  with  the  pathological  building  at  Bellevue. 
The  Bellevue  Trustees  asked  the  Commissioner  of  Charities  in 
January,  1912,  to  operate  this  new  morgue,  but  it  has  not  yet  been 
put  into  operation.     (Page  403.) 

B.  Conclusions: 

1.  The  facilities  afforded  in  the  old  morgue  for  performing 
autopsies  are  very  inadequate,  and  autopsies  cannot  be  satisfactor- 
ily conducted  under  existing  conditions. 

2.  The  new  morgue  in  the  pathological  building  has  been  lying 
idle  for  about  two  years  since  its  completion.  It  should  be  put  into 
operation. 

C.  Recommendations: 

I.  In  June,  1913,  the  Commissioner  of  Charities  submitted  to 
the  Secretarj'  of  the  Borough  of  Manhattan  a  suggested  list  of 
helpers  needed  to  operate  the  new  morgue.  The  number  of  such 
helpers  aggregated  34,  and  the  total  salaries,  $21,060.  It  is  recom- 
mended that  the  Commissioner  of  Charities  be  granted  23  helpers 
for  the  operation  of  the  morgue,  with  salaries  aggregating  $12,480. 
A  detailed  list  of  these  helpers  will  be  found  on  page  404. 


47 


SUMMARY  OF   FINDINGS, 
CONCLUSIONS,  AND   RECOMMENDATIONS 

WITH   REGARD   TO 

RATIO   OF  NURSES  TO   PATIENTS  PROPOSED  FOR 
MUNICIPAL  HOSPITALS 

A.  Summary  of  Findings: 

1.  No  recognized  ratio  of  the  number  of  nurses  to  patients 
cared  for  exists  in  connection  with  the  municipal  hospitals. 
(Page  407.) 

2.  No  standard  exists  by  which  the  appropriating  authorities 
of  the  City  may  judge  whether  or  not  a  request  for  additional 
nurses  for  a  particular  institution  should  or  should  not  be  granted. 
(Page  407.) 

3.  During  1912,  in  Kings  County  Hospital  there  was  i  trained 
nurse  to  each  21  beds,  with  14  admissions  per  bed  per  year.  In 
Metropolitan  Hospital,  General  Service,  there  was  i  trained 
nurse  to  each  24  beds,  with  8  admissions  per  bed  per  year.  In 
City  Hospital  there  was  i  trained  nurse  to  each  42  beds,  with  8 
admissions  per  bed  per  year.  Bellevue  Hospital,  exclusive  of 
special  services,  with  about  950  beds  and  about  24  admissions  yearly 
per  bed,  employed  i  trained  nurse  for  each  16  beds.     (Page  407.) 

B.  Conclusions: 

1.  There  seems  to  be  no  reasonable  ground  why  hospitals 
caring  for  the  same  class  of  patients  should  not  provide  the  same 
ratio  of  nurses  to  patients. 

2.  The  granting  of  a  request  from  a  particular  hospital  for 
an  increase  in  the  number  of  nurses  should  not  depend  upon  the 
amount  of  influence  which  the  training  school  or  other  officers  of 
that  hospital  can  bring  to  bear  upon  the  appropriating  authorities, 
but  should  depend  upon  a  need  which  may  be  recognized  and 
standardized. 

3.  All  of  the  hospitals  should  be  equipped  to  give  equally  good 
nursing  service. 

49 


5° 

C.  Recommendations: 


HOSPITAL   COMMITTEE 


I.  A  schedule  setting  forth  ratios  of  nurses  to  patients  in  hos- 
pitals varying  in  size  and  in  the  number  of  admissions  was  drawn 
up  and  presented  to  some  of  the  leading  nurses  of  the  country.  It 
was  the  consensus  of  opinion  of  these  nurses  that  a  schedule  of  the 
general  character  of  that  presented  would  be  practical  and  useful. 
This  schedule  is  set  forth  on  page  410.  It  is  recommended  that 
this  ratio  be  recognized  by  the  City  as  a  basis  for  appropriating 
funds  for  the  nursing  service  in  the  municipal  hospitals. 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,    AND    RECOMMENDATIONS 

WITH    REGARD   TO 

CHILDREN'S  SERVICES 

IN  THE 

MUNICIPAL  GENERAL    HOSPITALS  IN  MANHATTAN 
AND  THE  BRONX 

A.  Summaiy  of  Findings : 

1.  The  ratio  of  nurses  to  sick  children  is  much  smaller  in  our 
municipal  hospitals  than  in  the  best  private  hospitals.  The  ratio  in 
The  Babies'  Hospital  is  3  nurses  to  9  children.  In  Harlem  Hos- 
pital it  is  3  nurses  to  26  children;  in  Gouverneur  Hospital  3  to  30; 
Metropolitan  Hospital  3  to  26;  and  City  Hospital  3  to  16.  These 
nurses  have  no  special  training  in  the  care  of  children.     (Page  413.) 

2.  Only  Bellevue,  of  all  of  our  municipal  hospitals,  has  a  room 
where  the  temperature  can  be  forced  to  provide  for  certain  classes 
of  cases.  Wards  assigned  specifically  to  children  are  inadequate  in 
capacity  in  all  of  our  municipal  general  hospitals,  with  the  exception 
of  Bellevue.  Owing  to  this  fact  it  is  necessary  to  distribute  children 
in  adult  wards.  In  Fordham  Hospital  on  3  days  of  inspection  there 
were  in  the  children's  ward  21,  23,  and  23  children  respectively.  On 
the  same  days  there  were  in  the  whole  hospital  39,  50,  and  36 
children,  respectively.  The  capacity  of  the  children's  ward  in  City 
Hospital  is  16  beds.  On  3  days  of  inspection  there  were  in  the 
hospital  71,  72,  and  65  children,  respectively.     (Page  414.) 

3.  It  might  naturally  be  expected  that  Fordham  Hospital, 
serving  the  open  residence  districts  of  The  Bronx,  would  care  for 
a  larger  proportion  of  medical  cases  than  surgical.  On  the  con- 
trary, 56  per  cent,  of  its  cases  were  surgical,  whereas  but  27  per 
cent,  of  the  total  children's  cases  handled  by  Bellevue  were  surgical 
cases.  In  Gouverneur  Hospital,  located  in  a  district  where  the 
pressure  upon  life  is  great,  but  45  per  cent,  of  the  cases  were 
surgical.     (Page  415.) 

4.  The  average  stay  of  long  term  medical  cases  was  17  days 
in  Bellevue;  13  days  in  Harlem  Hospital;  and  16  days  in  each  of 
Fordham  and  Gouverneur  Hospitals.  The  acute  medical  cases  also 
remained  a  shorter  time  in  Harlem  Hospital  than  in  the  allied 
hospitals.  In  contrast  to  these  periods  of  stay,  in  Metropolitan 
Hospital,  on  Blackwell's  Island,  acute  medical  cases  remained 
on  an  average   35  days,  while  its  long  term  cases  remained  91 

51 


52  HOSPITAL   COMMITTEE 

days.    In  City  Hospital  the  average  length  of  stay  for  acute  cases 
was  27  days,  and  for  long  term  cases  49  days.     (Page  415.) 

5.  The  Bellevue  Hospitals  seem  able  to  get  rid  of  infectious 
cases  in  a  much  shorter  time  than  the  hospitals  on  Blackwell's 
Island.  The  average  length  of  stay  for  these  cases  was :  in  Ford- 
ham  7  days,  in  Harlem  Hospital  9  days,  and  in  Bellevue  9  days; 
whereas,  in  Metropolitan  Hospital  they  remained  57  days,  and  in 
City  Hospital  54  days.     (Pages  415  and  416.) 

6.  The  detention  rooms  in  all  of  the  hospitals,  with  the  excep- 
tion of  Bellevue,  are  very  inadequate.  Harlem  Hospital  has  one 
room,  with  an  allowance  of  273  cubic  feet  of  air  per  child.  It  is 
lighted  by  a  ground  glass  window,  and  opens  on  a  corridor  where 
the  ambulance  cases  are  received.  Gouverneur  Hospital's  single 
detention  room  is  but  a  short  distance  from,  and  opens  on,  the  same 
corridor  as  the  isolation  room.  At  Fordham  the  nurses  and  many 
of  the  visitors  pass  through  the  main  ward  to  reach  the  detention 
ward.  In  the  detention  ward  at  Harlem  Hospital,  on  a  day  of  in- 
spection, there  were  cases  of  appendicitis,  amputation,  pneumonia, 
tuberculosis,  and  normal  children.  Similar  conditions  were  found 
in  some  of  the  other  hospitals.     (Page  417.) 

7.  The  children's  ward  in  each  of  the  hospitals,  owing  to  the 
lack  of  detention  rooms,  is  frequently  quarantined.  This  occurred 
three  times  during  the  winter  of  19 13  at  Gouverneur  Hospital. 
One  child  in  Metropolitan  Hospital,  while  staying  at  the  hospital  7 
months  and  10  days,  had  whooping-cough,  measles,  pneumonia, 
abscess,  and  possibly  erysipelas.  Cross  infection  is  frequent,  and 
in  some  of  the  hospitals  sick  children  are  obliged  to  look  upon  the 
sufifering  and  death  agonies  of  other  children.     (Page  418.) 

8.  Not  a  few  normal  children  are  found  in  the  hospitals.  This 
is  more  especially  true  in  the  hospitals  on  Blackwell's  Island. 
(Page  419.) 

9.  It  is  a  noteworthy  fact  that  Bellevue,  with  a  high  class  chil- 
dren's service,  cares  for  children  from  all  over  the  City,  whereas 
each  of  the  other  hospitals  seems  to  serv'e  only  its  own  ambulance 
district,  which  is  a  restricted  area.     (Page  422.) 

B.  Conclusions: 

1.  The  inadequate  number  of  nurses  provided  for  the  care  of 
children  is  not  due  so  much  to  the  failure  of  the  hospital  authorities 
to  recognize  the  need,  but  rather  to  lack  of  institutional  appro- 
priations. 

2.  The  inadequacy  of  wards  for  the  care  of  children  in  con- 
nection with  our  municipal  hospitals  is  more  largely  due  to  the 
fact  that  at  the  time  the  hospitals  were  built  the  need  for  special- 
ized care  for  children  was  not  so  well  recognized  as  at  the  present 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  53 

time.  Reasonably  acceptable  accommodations  have  been  provided 
at  Bellevue,  and  also  in  a  new  pavilion  just  completed  at  Kings 
County  Hospital.  The  authorities  have  been  slow  to  recognize  the 
need  in  the  other  hospitals,  and  have  not  put  forward  sufficient 
effort  to  induce  the  City  to  appropriate  funds  for  proper  accommo- 
dation. 

3.  There  seems  to  be  no  adequate  explanation  of  the  fact  that 
Fordham  Hospital,  located  in  a  sparsely  settled  residential  district, 
has  a  larger  percentage  of  surgical  Cases  than  any  of  the  other 
municipal  hospitals  in  the  Department  of  Bellevue  and  Allied  Hos- 
pitals. 

4.  The  fact  that  the  average  stay  of  medical  cases  is  mater- 
ially shorter  in  the  allied  hospitals  of  the  Bellevue  Department 
than  in  Bellevue  proper  seems  to  indicate  that  the  services  in  the 
allied  hospitals  are  inadequate,  overcrowded,  and  that  the  hos- 
pitals are  obliged  to  discharge  the  children  without  adequate  treat- 
ment. The  excessively  long  stay  of  children  in  the  hospitals  on 
Blackwell's  Island  is  not  due  to  better  treatment  of  the  children, 
since  the  facilities  in  these  hospitals  are  much  poorer  than  in  Belle- 
vue and  Allied  Hospitals,  but  it  is  due  rather  to  admitting  many 
normal  children,  and  retaining  many  who  have  been  cured  and  who 
should  have  been  discharged. 

5.  The  length  of  stay  of  infectious  cases  in  the  different  hospi- 
tals should  not  vary  materially,  and  the  contrast  of  an  average  stay 
of  57  days  in  Metropolitan  Hospital,  with  9  days  in  Bellevue  and 
Harlem  Hospitals,  seems  to  indicate  a  failure  on  the  part  of  Metro- 
politan Hospital  to  properly  reexamine  and  discharge  patients  on 
the  termination  of  their  illnesses. 

6.  The  detention  rooms  in  all  of  the  hospitals,  with  the  excep- 
tion of  Bellevue,  are  very  inadequate,  and  it  will  be  impossible  to 
entirely  avoid  cross  infections  so  long  as  it  is  impracticable  to  de- 
tain children  in  these  rooms  a  sufficient  length  of  time  to  allow  a 
possible  contagion  to  develop.  With  the  lack  of  detention  facilities 
in  most  of  our  municipal  hospitals,  a  child  entering  a  hospital  is  in 
serious  danger  of  contracting  diseases  other  than  that  which  causes 
it  to  enter  the  hospital. 

7.  Inasmuch  as  it  seems  conclusive  that  mothers  will  take 
their  children  long  distances  to  a  children's  service  in  which  they 
have  confidence,  it  is  of  great  importance  that  the  character  of  the 
children's  services  in  connection  with  all  of  our  municipal  hospitals 
be  raised  to  a  higher  standard  as  rapidly  as  possible.  The  willing- 
ness of  the  mother  to  take  her  child  to  a  distant  part  of  the  City  in 
order  to  reach  a  children's  service  in  which  she  has  confidence 
makes  it  possible  to  centralize  some  of  the  children's  services, 
rather  than  to  attempt  to  develop  a  complete  service  at  each  of  the 
smaller  hospitals. 


54 


HOSPITAL   COMMITTEE 


C.  Recommendations: 

1.  A  children's  service  complete  in  all  particulars  and  equipped 
to  properly  care  for  any  type  of  children's  ailment  should  be 
provided,  one  in  Manhattan  and  one  in  Brooklyn.  The  proper 
location  of  such  a  complete  service  in  Manhattan  is  at  Bellevue 
Hospital,  where  adequate  space  can  be  provided  and  the  attendance 
of  the  highest  grade  of  physicians  secured.  In  Brooklyn,  such  a 
complete  service  should  be  located  at  Kings  County  Hospital. 
Such  a  service  is,  in  a  large  measure,  provided  for  at  the  present 
time  at  Kings  County  Hospital  by  the  erection  of  a  new  pavilion 
devoted  exclusively  to  children,  which  was  opened  after  October  i, 

1913- 

2.  The  smaller  hospitals,  both  in  the  Department  of  Bellevue 
and  Allied  Hospitals  and  in  the  Department  of  Public  Charities, 
should  provide  services  adequate  for  the  general  run  of  acute  cases, 
both  surgical  and  medical.  Provision  should  not  be  made,  how- 
ever, for  the  exceptional  case  which  requires  special  apparatus, 
facilities,  or  treatment.  Such  cases  should  be  sent  in  Manhattan  to 
Bellevue,  and  in  Brooklyn  to  Kings  County  Hospital;  nor  should 
provision  be  made  in  these  hospitals  for  the  long  term  cases. 

3.  The  pressure  upon  the  children's  services  in  each  of  the 
subsidiary  hospitals  of  the  Bellevue  Department  indicates  that  addi- 
tional beds  are  needed.  This  pressure  is  most  noticeable  in  con- 
nection with  Gouverneur  and  Harlem  Hospitals,  and,  as  soon  as 
possible,  relief  should  be  secured  by  the  construction  of  at  least  one 
additional  ward  in  each  of  these  hospitals.  The  additional  facil- 
ities needed  in  connection  with  the  number  of  beds  at  present  pro- 
vided may  be  indicated  as  follows : 

Gouverneur  Hospital 

At  present  Gouverneur  Hospital  has  10  beds  in  one  ward  used 
for  detention.  These  beds,  with  others  added,  should  be  placed  in 
smaller  wards  somewhat  as  follows:  4  wards  of  i  bed  each;  3 
wards  of  2  beds  each;  2  wards  of  3  beds  each.  If  this  number  of 
beds  is  not  sufficient  for  adequate  detention,  the  least  suspicious 
cases,  after  having  been  detained  for  a  reasonable  length  of  time, 
can  be  placed  in  the  main  ward,  separated  from  other  patients  by 
screens.  At  present  the  hospital  has  one  isolation  ward,  with  3 
beds.  It  is  important  that  these  3  beds  be  placed  either  in  separate 
rooms  or  in  proper  cubicles.  At  the  present  time  the  cribs  for  new- 
born babies  are  in  the  maternity  ward.  It  would  be  highly  advis- 
able to  provide  a  small  ward  for  such  cribs. 

The  hospital  has  no  recovery  and  dressing  room  for  the  chil- 
dren's service.  It  would  seem  important  that  one  recovery  and  one 
dressing  room  be  provided  in  connection  with  the  surgical  ward. 
A  high  temperature  room  should  be  provided  unless  the  policy  is 
adopted  of  transferring  all  cases  needing  such  care  to  Bellevue. 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  55 

There  is  no  separate  ward  space  for  tonsil  and  adenoid  cases.  It 
would  seem  advisable  to  provide  a  ward  for  such  a  purpose,  that 
could  be  used  for  cases  operated  on  in  both  the  hospital  and  in  the 
Out-Patient  Department.  As  soon  as  room  can  be  provided  the 
surgical  and  medical  cases  should  be  separated.  At  the  present 
time  the  up-patient  children  are  fed  in  the  diet  kitchen.  It  is  desir- 
able that  they  have  a  separate  dining  room,  both  for  medical  and 
surgical  cases,  if  such  can  be  provided. 

A  paid  resident  in  charge  of  the  children,  giving  continuous 
service,  is  needed  at  Gouverneur  Hospital.  It  is  recommended  that 
one  be  employed  at  the  rate  of  $600  per  year. 

It  is  recommended  that  a  salary  sufficient  to  retain  a  nurse  spe- 
cially trained  in  the  care  of  children  be  provided. 

Harlem  Hospital 

The  lack  of  detention,  isolation,  and  other  auxiliary  rooms  will 
be  largely  met  by  the  reconstruction  which  is  at  present  being 
planned,  and  for  which  appropriation  has  been  made. 

Fordham  Hospital 

Fordham  Hospital  has  sufficient  bed  capacity  for  children.  The 
42  beds  it  now  maintains,  however,  should  be  separated  into  a  med- 
ical and  a  surgical  ward.  At  the  present  time  it  has  20  beds  in  one 
detention  room.  This  space  should  be  subdivided  by  screens  to 
make  smaller  ward  areas. 

A  recovery  and  dressing  room  is  needed  each  for  the  surgical 
and  medical  divisions.  A  high  temperature  room  should  be  pro- 
vided, unless  the  policy  is  adopted  of  transferring  cases  needing 
such  care  to  Bellevue  Hospital.  No  special  room  is  provided  for 
the  use  of  tonsil  and  adenoid  cases.  A  separate  ward  for  such 
cases  is  needed.  The  convalescent  children  have  no  space  except 
on  the  verandas.    A  room  is  needed  for  such  convalescing  children. 

It  is  recommended  that  a  paid  resident  in  charge  of  the  children 
be  provided  on  the  same  basis  as  is  recommended  in  connection 
with  Gouverneur  Hospital. 

A  salary  sufficient  to  secure  and  retain  a  nurse  thoroughly 
trained  in  the  care  of  children  should  be  provided. 

While  it  is  impracticable  at  the  present  time  to  secure  all  of  the 
above  recommended  rooms  in  connection  with  Gouverneur  and 
Fordham  Hospitals,  a  portion  of  these  rooms  can  be  secured  by 
erecting  partitions  in  the  space  already  provided.  Other  rooms 
must  necessarily  wait  until  the  buildings  at  these  hospitals  are  en- 
larged and  extended,  but  the  needs  of  the  children's  service  should 
be  constantly  borne  in  mind  and  these  facilities  provided  at  the 
earliest  possible  date. 


56  HOSPITAL   COMMITTEE 

4.  Owing  to  the  pressure  upon  the  existing  children's  services 
it  is  impossible  to  keep  children  having  long  term  ailments  a  suf- 
ficient length  of  time,  and  inasmuch  as  all  of  the  hospitals  in  IMan- 
hattan  are  located  in  crowded  sections,  without  surrounding  space 
or  lawns,  they  afford  inadequate  provision  for  the  treatment  of 
convalescent  cases.  It  would  seem  highly  advisable  to  erect  a  chil- 
dren's hospital  devoted  largely  to  the  care  of  long  temi  cases, 
and  for  convalescent  children.  Such  a  hospital  should  be  erected 
where  there  is  abundant  space  surrounding  it,  mainly  devoted  to 
lawns  and  play  spaces  for  children. 

It  is  recommended  that  a  long  term  children's  hospital  be  con- 
structed on  Blackwell's  Island,  the  central  portion  of  such  hospital 
to  be  located  near  the  southern  boundary  of  the  plot  occupied  by 
the  City  Home,  and  to  develop  to  the  south ;  the  hospital  to  be  so 
laid  out  that  it  may  ultimately  accommodate  1,000  children. 

5.  Owing  to  the  inaccessibility  of  Randall's  Island  it  is  recom- 
mended that  the  sick  children  (those  not  feeble-minded)  be  re- 
moved from  Randall's  Island  and  placed  in  a  long  term  chil- 
dren's hospital  in  case  one  should  be  erected  on  Blackwell's  Island. 


ARGUMENTS    IN    SUPPORT    OF    RECOMMENDATIONS 

General  Statement 

It  has  been  the  endeavor  to  secure  the  opinion  of  some  of  the  leading 
children's  specialists,  both  in  New  York  City  and  elsewhere,  with  regard 
to  the  best  hospital  system  for  children.  These  specialists  were  asked 
which,  in  their  opinion,  is  the  more  desirable:  a  special  children's  hospital 
wherein  all  classes  of  cases  would  be  treated,  or  children's  services  in  con- 
nection with  existing  general  hospitals.  The  general  consensus  of  opinion 
was  that  children  would  be  better  cared  for  in  services  connected  with  gen- 
eral hospitals  than  in  special  children's  hospitals  having  no  connection  with 
a  general  hospital.  On  the  other  hand,  it  was  their  opinion  that  long-term 
cases,  especially  those  needing  outdoor  treatment,  would  be  better  cared 
for  in  a  hospital  located  either  in  the  country,  or  in  a  place  where  abundant 
space  was  available  around  the  hospital.  It  was  their  opinion,  moreover, 
that  a  complete  children's  service  for  acute  cases  could  not  readily  be  main- 
tained except  in  connection  with  a  large  general  hospital,  and  that  small 
hospitals  should  not  endeavor  to  maintain  a  service  except  for  the  general 
run  of  acute  cases. 

The  recommendations  in  this  Report  have  followed,  so  far  as  practicable, 
the  opinions  of  these  specialists. 

(i  &  2)     Complete  Children's  Services  at  Bellevue  and  Kings 
County  Hospitals 

According  to  the  opinion  of  the  children's  specialists,  as  stated  above, 
there  should  be,  in  some  convenient  location,  a  complete  service  for  chil- 
dren where  all  cases  needing  exceptional  treatment  and  provision  can 
be  cared  for.  New  York  City  is  probably  large  enough  to  require  two 
such  complete  services,  and  the  most  appropriate  place  for  these,  as  has 
been  recommended,  is  at  Bellevue  Hospital  and  at  Kings  County  Hospital. 
Each  of  these  hospitals  serves  a  large  territory.  The  children's  services  in 
these  hospitals  should  be  made  complete  in  every  particular,  so  that  ex- 
ceptional cases  of  whatever  nature  may  here  receive  the  best  treatment 
according  to  present-day  knowledge.  Having  provided  these  two  complete 
services,  it  would  seem  inadvisable  to  provide  equipment  in  subsidiary  hos- 
pitals for  other  than  the  common  run  of  acute  cases.  According  to  this 
plan,  in  Brooklyn,  the  Cumberland  Street,  Coney  Island,  Greenpoint,  and 
Bradford  Street  Hospitals  would  have  a  limited  provision  for  the  care  of 
children,  and  would  transfer  to  Kings  County  Hospital  all  cases  requiring 
special  facilities  or  skill  in  handling.  Likewise,  in  Manhattan  and  The 
Bronx,  Gouverneur,  Harlem,  and  Fordham  Hospitals  would  transfer  acute 
cases  of  a  special  character  to  Bellevue.  By  this  method  all  classes  of  cases 
could  receive  adequate  care. 

(3)    Advisable  Changes  in  Provision  for  Children's  Services  at  Gouverneur, 
Harlem,  and  Fordham  Hospitals 

The  only  safeguard  against  the  spread  of  contagion  in  children's  wards 
is  the  detention,  for  a  reasonable  length  of  time,  of  in-coming  cases.  Hos- 
pitals that  are  not  provided  with  suitable  detention  rooms  are  not  infre- 

57 


58  HOSPITAL   COMMITTEE 

quently  obliged  to  quarantine  children's  wards,  thus  materially  limiting  the 
service  they  can  render,  and  also  jeopardizing  the  lives  of  children  in  the 
wards.  It  is  of  prime  importance,  therefore,  that  each  hospital  should  have 
an  adequate  number  of  detention  rooms,  containing  one  or  a  few  beds, 
wherein  all  in-coming  children  may  be  placed  for  a  few  days  to  await 
development  of  any  contagious  diseases  with  which  they  may  possibly  be 
infected.  Since  Bellevue  Hospital  became  equipped  with  a  reasonable  num- 
ber of  detention  rooms  the  spread  of  contagious  diseases  in  the  wards  has 
been  rare. 

The  Children's  Service  at  Bellevue  has  been  greatly  improved  of  recent 
years,  due  largely  to  the  fact  that  a  paid  children's  specialist  has  been 
employed  to  give  continuous  service.  A  rotating  service  does  not  secure 
satisfactory  results  with  adults,  and  much  less  so  with  children.  Sick  children 
need  to  be  under  constant  supervision,  and  such  supervision  is  not  secured 
when  attending  physicians  rotate  in  service. 

It  has  been  the  custom  heretofore  to  rotate  nurses  through  the  children's 
service,  as  through  other  services,  in  order  that  they  may  receive  a  rounded 
training  in  a  variety  of  services.  By  this  method,  a  head  nurse  with  no 
knowledge  of  the  care  of  children  has  frequently  been  placed  in  charge  of 
the  children's  service.  It  is  highly  advisable  that  this  practice  should  be  dis- 
continued, and  that  a  nurse  be  placed  in  charge  of  the  children's  service  who 
would  render  continuous  and  abiding  service,  and  such  rotating  of  nurses 
as  may  seem  necessary  or  advisable  take  place  beneath  the  head  nurse. 
Continuous  service  in  connection  with  the  nursing  of  children  is  even  more 
necessary  and  advisable  than  in  connection  with  medical  attendance. 

(4)    A  Long  Term  Children's  Hospital  on  Blackwell's  Island 

As  previously  stated,  it  seems  to  be  the  consensus  of  opinion  of  chil- 
dren's specialists  that  it  is  advisable  to  have  a  long  term  children's  hospital 
to  which  long  term  cases  may  be  transferred  from  acute  hospitals.  In 
order  to  insure  the  attendance  of  high  grade  children's  specialists  a  large 
number  of  children  must  be  gathered  together  in  such  a  hospital.  A  limited 
service,  for  instance,  in  connection  with  ]\Ietropolitan  and  City  Hospitals, 
would  probably  not  attract  the  grade  of  children's  specialists  desired.  To 
induce  Bellevue  and  its  Allied  Hospitals  to  transfer  children's  cases  to 
another  hospital  the  latter  must  be  of  the  highest  grade  and  provide  the 
best  care  obtainable.  Such  grade  of  service,  it  is  believed,  is  not  likely 
to  be  secured  except  in  connection  with  a  hospital  specially  designed  for 
the  care  of  children,  and  which  would  attract  the  best  of  specialists  be- 
cause of  the  large  number  of  children  treated. 

Since  large  factors  in  the  treatment  of  long  term  cases  are  fresh  air 
and  sunshine,  it  is  highly  advisable  that  such  a  hospital  should  be  placed 
on  one  of  the  islands  in  the  East  River,  where  there  is  an  abundance  of  air 
and  sunshine. 

Inasmuch  as  a  children's  hospital  already  exists  on  Randall's  Island, 
accommodating  about  500  children,  it  would  seem  advisable  to  perfect  and 
enlarge  it  for  such  a  hospital  were  there  not  strong  reasons  for  locating  it 
elsewhere.  It  is  true  that  Randall's  Island  has  about  84  acres  which  can 
be  devoted  to  this  purpose,  and  that  it  is  well  covered  with  trees  and  other- 
wise attractive,  and  also  that  it  would  be  more  economical  to  enlarge  this 
existing  hospital  than  to  construct  a  new  one,  either  on  Randall's  Island 
or  elsewhere,  but  the  buildings  at  present  used  as  the'  children's  hospital 


FINDINGS.   CONCLUSIONS   AND   RECOMMENDATIONS  59 

are  old,  and  would  need  to  be  renewed  in  a  comparatively  few  years, 
so  that  if  nearly  the  whole  hospital  plant  would  have  to  be  reconstructed 
it  could  be  done  as  cheaply  elsewhere  as  on  Randall's  Island.  Since  such 
reconstruction  is  probably  advisable  and  necessary  the  problem  resolves 
itself  into  a  question  of  location,  with  the  cost  of  reconstruction  eliminated. 

Though  Randall's  Island  has  the  advantage  of  an  abundance  of  ground, 
it  has  the  disadvantage  of  isolation.  It  is  not  connected  with  the  main- 
land by  a  bridge,  and  probably  never  will,  owing  to  the  great  expense 
of  the  construction  of  such  a  connection.  It  will,  therefore,  be  necessary  to 
continue  ferry  service  to  the  Island  as  the  only  means  of  communication. 
Because  of  this  fact,  Randall's  Island  will  always  be  more  or  less  inac- 
cessible. It  will  be  practically  impossible  to  get  an  attending  physician  to 
the  Island  on  an  emergency  call,  which  fact  will  result  in  leaving  very  sick 
children  largely  in  the  care  of  internes.  This  situation  has  not  been 
serious  in  the  past  because  of  the  class  of  children's  cases  cared  for  at 
the  institution  on  Randall's  Island.  Few  of  the  cases  have  ailments  which 
develop  acute  conditions.  If,  however,  the  system  were  adopted  of  trans- 
ferring from  Bellevue  and  Allied  Hospitals  all  cases  likely  to  remain  over 
possibly  35  days,  it  would  result  in  a  different  class  of  cases  going  to  the 
long  term  hospital — cases  which  not  infrequently  would  require  the  im- 
mediate attention  of  the  attending  physician.  It  is  doubtful  whether  such 
attendance  could  be  secured  on  Randall's  Island,  and  for  that  reason  prob- 
ably Bellevue  and  its  Allied  Hospitals  could  not  be  induced  to  send  this 
class  of  cases  to  a  children's  hospital  thus  isolated. 

It  is  the  intention  of  the  City  ultimately  to  remove  the  Penitentiary 
and  the  Workhouse  from  Blackwell's  Island.  For  certain  reasons  it  would 
also  seem  desirable  to  remove  the  City  Home  from  Blackwell's  Island. 
In  case  these  three  institutions  were  removed  80  acres  of  land  would  be 
left  available  for  the  purpose  of  a  hospital,  a  space  about  equal  to  that  on 
Randall's  Island.  This  space,  though  not  as  well  distributed  as  on  Ran- 
dall's Island,  nevertheless  would  give  abundant  play  space  for  children 
were  it  occupied  by  a  children's  hospital. 

The  chief  advantage  of  Blackwell's  Island  as  a  site  for  a  hospital  is 
that  it  is  crossed  by  a  bridge  connecting  both  Manhattan  and  Queens. 
Elevator  connection  could  be  made  between  the  island  and  the  bridge  at 
a  comparatively  small  expense,  and  in  a  short  space  of  time.  After  such 
installation  the  Island  would  be  nearly  as  accessible  to  attending  physicians 
and  the  friends  of  patients  as  the  mainland.  A  hospital  thus  located  could 
secure  the  services  of  physicians  and  surgeons  from  either,  or  both,  City 
and  Metropolitan  Hospitals,  which  would  give  such  a  children's  hospital 
practically  the  same  advantages  of  service  as  though  it  were  connected 
directly  with  a  general  hospital,  and  were  on  the  mainland. 

Within  a  comparatively  few  years  the  Queens  territory  will  probably 
be  as  densely  populated  as  The  Bronx  is  to-day.  When  this  development 
takes  place  it  will  be  necessary  to  furnish  hospital  facilities  to  the  inhabi- 
tants of  that  territory.  Blackwell's  Island  is  very  accessible  to  that  territory 
by  way  of  the  Queensboro  Bridge,  and  it  would  probably  be  unnecessary  to 
build  any  hospitals  in  that  district  for  many  years  to  come  if  Blackwell's 
Island  were  made  accessible  by  means  of  elevators  to  the  bridge.  Thus, 
material  economy  would  be  secured  by  utiHzing  the  hospitals  on  Black- 
well's Island  to  serve  the  Queens  territory. 

Mothers  are  loath  to  send  children  to  a  hospital  under  any  circum- 
stances, and  more  especially  to  a  hospital  that  is  inaccessible,  where  they 


6o  HOSPITAL   COMMITTEE 

find  it  difficult  to  make  frequent  visits.  For  this  reason  it  is  probable  that 
a  children's  hospital  on  Randall's  Island  would  never  serve  its  full  purpose, 
whereas,  were  it  located  on  Blackwell's  Island,  mothers  could  reach  it  with 
about  the  same  ease  as  though  it  were  on  the  mainland,  and,  owing  to  this 
fact,  would  probably  much  more  readily  allow  their  children  to  go  to  a 
hospital  thus  located. 

It  would  seem  practicable  and  expedient  to  start  a  children's  hospital  near 
the  southerly  boundary  line  of  the  plot  occupied  by  the  City  Home  and 
locate  additional  buildings  to  the  southward,  where  there  is  a  large  tract  of 
open  territory.  As  such  a  hospital  developed  it  would  probably  be  found 
feasible  and  advisable  to  remove  the  City  Home  from  the  Island,  thus 
making  available  the  space,  and  possibly  some  of  the  buildings,  which  it 
now  occupies.  After  the  new  hospital  were  sufficiently  developed,  all  of 
the  hospital  children  from  Randall's  Island  could  be  transferred  to  it. 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,   AND   RECOMMENDATIONS 

WITH     REGARD    TO 

PHYSICAL    EXAMINATION    AND    EMPLOYMENT    OF 
DEPENDENTS  IN   CITY  HOMES    (ALMSHOUSES) 

A.  Summary  of  Findings: 

1.  Aside  from  those  occupied  in  the  care  of  the  institution, 
less  than  50  inmates  are  employed  at  industrial  work  in  the  Man- 
hattan City  Home.  These  are  occupied  in  making  brooms,  mat- 
tresses, clothing,  and  repairing  shoes.  In  the  Brooklyn  Home  about 
75  are  so  employed  and  do  the  same  things  as  are  done  in  the  Man- 
hattan Home.  At  Farm  Colony,  in  addition  to  those  employed  on 
the  farm  and  in  cormection  with  the  institution,  about  75  at  times 
are  employed  in  mat  making  and  sewing.     (Page  437.) 

2.  Inmates  admitted  to  the  City  Homes  are  examined  physi- 
cally only  to  the  extent  necessary  to  determine  whether  or  not  they 
should  enter  an  almshouse  or  hospital.     (Page  437.) 

3.  Whether  or  not  an  inmate  should  be  put  to  work,  and  the 
nature  of  such  work,  is  dependent  upon  the  judgment  of  a  lay 
superintendent.     (Page  438.) 

4.  No  consistent  method  of  determining  the  degree  of  health  or 
sickness  of  inmates  exists.     (Page  438.) 

5.  A  thorough  physical  examination  was  made  of  over  500 
inmates  at  the  Manhattan  Home,  under  the  direction  of  Dr.  L.  L. 
Williams,  now  at  the  head  of  the  United  States  Public  Health 
Service  at  Ellis  Island.  The  results  of  said  examination  may  be 
summarized  as  follows : 

Of  the  male  inmates,  4.3  per  cent,  were  able  to  do  heavy  farm 
work ;  8.2  per  cent,  were  in  condition  to  do  heavy  mechanical  work ; 
3.7  per  cent,  were  able  to  do  light  farm  work ;  7.2  per  cent,  were  able 
to  do  domestic  work ;  6  per  cent,  could  do  non-sedentary  light  me- 
chanical work;  and  29  per  cent,  were  able  to  perform  light  me- 
chanical work  of  a  sedentary  nature.  Of  the  total,  60  per  cent, 
were  able  to  do  work  of  some  form.  Of  the  remaining  40  per 
cent.,  19  per  cent,  were  so  crippled  and  infirm  as  to  be  unable  to  do 
any  work,  and  the  remaining  21  per  cent,  were  in  need  of  daily 
medical  attention  and  should  have  been  assigned  to  hospital  wards. 
(Page  441.) 

6.  It  may  be  estimated  on  the  basis  of  the  close  physical  exam- 
ination made  under  the  supervision  of  Dr.  Williams  that  approxi- 

61 


62  HOSPITAL   COMMITTEE 

mately  3,000  inmates  should  be  able  to  do  some  physical  work.    At 
the  present  time  less  than  1,500  are  employed.     (Page  439.) 

7.  Full  instruction  as  to  the  method  to  be  employed  in  making 
physical  examination  of  inmates  is  set  forth  in  the  Report.  (Pages 
444  to  450.) 

8.  An  examination  of  certain  almshouses  in  other  states  was 
made  to  determine  the  proportion  of  inmates  employed.  In  the 
City  almshouse  in  St.  Louis,  out  of  675  inmates,  500  were  daily 
employed  for  an  average  of  5  hours  per  day.  They  performed  all 
the  laundry  work  of  the  institution,  did  all  the  sewing,  made  all  the 
clothing  and  shoes,  made  soap  for  their  own  and  other  institutions, 
manufactured  mattresses  for  their  own  and  other  institutions,  con- 
structed a  large  portion  of  the  furniture  used  in  the  Almshouse,  and 
bound  all  the  books  in  the  library  of  the  institution.  In  no  alms- 
house visited  did  the  inmates  appear  more  contented  and  happy  than 
in  this.     (Page  451.) 

Of  the  725  male  inmates  in  the  almshouse  in  Philadelphia,  600 
were  daily  employed,  chiefly  in  the  care  of  their  own  and  several 
other  institutions  associated  with  it.  In  addition  to  such  work,  they 
made  shoes,  wove  cloth,  made  clothing,  mattresses,  brooms,  and  did 
printing.     (Page  451.) 

9.  The  value  of  farm  products  at  Farm  Colony  for  the  year 
191 1  averaged  $168  per  acre.  Nearly  the  entire  acreage  was  de- 
voted to  the  raising  of  vegetables.  The  State  Farms  in  Massachu- 
setts are  in  the  main  devoted  to  general  farming.  The  farm  of  the 
State  Hospital  in  Worcester  in  191 1  produced  farm  products  to 
the  value  of  $341  per  acre.  Medfield  Farm  produced  farm  products 
to  the  value  of  $524  per  acre.  The  products  of  Foxborough  Farm 
were  valued  at  $353  per  acre.  The  farm  connected  with  Man- 
hattan State  Hospital  on  Ward's  Island,  New  York  City,  is  devoted 
entirely  to  garden  truck.  On  its  63  acres  in  191 1  $25,870  worth  of 
vegetables  were  produced.  Farm  Colony,  devoted  to  like  crops, 
produced  but  $8,051  worth  of  products,  if  estimated  at  the  same 
prices  used  by  Manhattan  State  Hospital.  (Pages  452,  453  and 
4.54.) 

B.  Conclusions: 

1.  Inasmuch  as  the  physical  examination  of  inmates  made  by 
this  Committee  has  shown  that  about  60  per  cent,  of  the  inmate 
population  are  able  to  do  some  form  of  work,  it  seems  highly  de- 
sirable, both  for  the  welfare  of  the  inmates  and  for  the  economy 
of  operation  of  the  institutions,  that  such  of  the  inmates  in  this  class 
as  are  not  now  employed  should  be  provided  with  work  of  a  char- 
acter suited  to  their  condition. 

2.  Farm  Colony  is  not  now  successfully  operated.  It  could 
produce,  if  properly  managed,  two  or  three  times  the  value  of 
products  which  it  is  now  producing.  There  are  at  the  Colony 
about  750  men  and  250  women.    The  average  number  of  patients  at 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  63 

Manhattan  State  Hospital  used  for  the  cultivation  of  its  farm  is 
about  80.  It  seems  highly  improbable  that  out  of  the  750  men, 
supposed  to  be  sent  to  Farm  Colony  because  they  are  relatively  able- 
bodied,  there  could  not  be  selected  a  sufficient  number  to  properly 
cultivate  70  acres  of  land,  since  Manhattan  State  Hospital  is  able  to 
cultivate  its  63  acres  with  80  men. 

3.  The  investigation  has  shown  that  quite  a  large  proportion 
of  the  inmates  of  Farm  Colony  are  crippled,  infirm,  and  senile,  and 
are  not  of  the  class  that  for  a  number  of  years  after  the  opening  of 
Farm  Colony  were  sent  there.  It  is  quite  probable  that  a  cer- 
tain proportion  of  the  relatively  able-bodied  men  and  women  are 
occupied  in  caring  for  those  that  are  less  able.  Inasmuch  as  the 
farm  is  less  productive  now  than  it  was  when  it  had  much  fewer 
inmates  and  less  paid  help,  it  seems  probable  that  the  policy  of  send- 
ing the  infirm  to  Farm  Colony  has  not  only  lessened  the  value  of 
farm  products,  but  has  in  quite  a  measure  destroyed  the  primary 
and  fundamental  conception  of  Farm  Colony  as  a  place  wherein 
to  occupy  the  man  discouraged,  out  of  work,  and  partially  in- 
capacitated. 

C.  Recommendatioiis: 

1.  A  medical  officer  should  be  provided,  who  would  make  de-  i 
tailed  physical  examination  of  all  inmates  admitted  to  the  alms- 
houses. (This  recommendation  is  set  forth  in  detail,  beginning 
on  page  65.)  Subsequent  to  the  admission  of  inmates,  a  medical 
officer  should  periodically  inspect  the  inmates  to  ascertain  their 
physical  condition  and  the  progress  of  any  disease  with  which  they 
may  be  afflicted.  Such  examination  should  determine  whether  or 
not  they  are  being  employed  at  suitable  work,  and  for  the  number 
of  hours  which  their  degree  of  strength  warrants. 

2.  Install  at  once  at  the  City  Homes  on  Blackwell's  Island  and 
in  Brooklyn  sufficient  devices  and  machinery  to  employ  25  per  cent, 
of  those  able  to  work ;  such  machinery  to  be  of  a  simple  form  and 
requiring  little  manual  labor.  If,  after  the  operation  of  such  ma- 
chinery, the  plan  of  employing  the  inmates  seems  feasible  and  ca- 
pable of  extension,  install  a  sufficient  amount  of  machinery  and 
devices  to  employ  all  those  in  the  institutions  not  actually  in  the 
hospital  or  neurological  division  or  employed  in  connection  with 
the  operation  of  the  institution. 

3.  If  after  investigation  it  is  found  suitable,  devote  the  low  ^ 
lands  of  Farm  Colony  to  the  raising  of  willow,  from  which  baskets 
and  other  willow  containers  and  furniture  may  be  manufactured, 
and  occupy  a  certain  proportion  of  the  men  during  the  winter  in 
the  manufacture  of  these  willow  articles. 

Install  machinery  and  devices  of  a  suitable  character  to  employ 
the  relatively  able-bodied  men  at  Farm  Colony  during  the  winter 
months. 


64  HOSPITAL  COMMITTEE 

4.  Employ  an  instructor  in  industrial  work  for  each  of  the 
City  Homes,  at  a  salary  of  from  $900  to  $1,200  per  year. 

5.  Ask  the  State  Department  of  Agriculture  to  inspect  the 
farm  at  Farm  Colony  and  make  suggestions  as  to  methods  which 
will  secure  the  maximum  amount  of  products.  The  right  to  make 
such  examinations  on  the  part  of  the  State  Department  of  Agricul- 
ture is  provided  for  in  Chapter  460,  Laws  of  1913. 

6.  Remove  from  Farm  Colony  all  crippled,  infirm,  and  senile 
v'     inmates,  and  erect  no  more  dormitories  at  the  Colony.    The  capacity 

at  present  is  larger  than  is  needed  to  accommodate  all  of  the  rela- 
tively able-bodied  men  not  required  in  connection  with  the  care  and 
maintenance  of  the  City  Homes  on  Blackwell's  Island  and  in 
Brooklyn. 

7.  Provide  only  a  temporary  detention  room  for  the  insane 
at  Farm  Colony,  and  transfer  all  alleged  insane  for  examination 
and  observation  to  Bellevue  or  Kings  County  Hospitals. 


ARGUMENTS    IN    SUPPORT    OF    RECOMMENDATIONS 

(i)  Physical  Examination  of  Inmates 

Arguments  in  support  of  the  advisability  of  making  such  examination 
are  set  forth  on  page  437  and  following  pages. 

(2)  Installation  of  Machinery 

That  not  a  large  proportion  of  the  inmates  are  at  present  employed  is 
set  forth  on  subsequent  pages,  and  that  some  large  almshouses  employ 
a  much  larger  percentage  than  do  the  almshouses  in  New  York  City  is  also 
shown.  The  physical  examination  made  by  the  Committee  has  clearly  dem- 
onstrated that  about  60  per  cent,  of  the  inmates  are  able  to  work.  But,  as 
many  of  these  inmates  would  be  obliged  to  do  sedentary  work,  and  many 
also  to  perform  only  the  lightest  kind  of  labor,  and  as  it  would  be  an  ex- 
periment to  install  machinery  and  devices  for  the  employment  of  those  not 
already  employed  in  the  care  of  the  institutions,  it  would  seem  advisable  to 
employ  only  inexpensive  machinery ;  such  as  machines  for  knitting  socks, 
mittens,  sweaters,  etc.;  devices  used  in  connection  with  braiding  rugs;  an3 
such  other  machinery  and  devices  as  can  be  used  by  those  having  compara- 
tively little  strength.  It  would  also  seem  advisable  to  obtain  at  the  present 
time  only  enough  to  employ  not  more  than  25  per  cent,  of  those  unemployed. 
After  such  machinery  has  been  installed,  and  if  the  plan  seems  to  work 
satisfactorily,  additional  machinery  can  be  secured. 

(3)  Raising  of  Willow  for  Furniture  and  Containers 

Willow  is  successfully  raised  by  the  State  Hospital  at  Crownsville,  Md. 
It  seems  probable  that  the  low  land  at  Farm  Colony  is  suitable  for  willow 
culture.  The  making  of  willow  furniture  and  containers  does  not  require 
great  skill,  and  it  is  a  class  of  work  that  would  be  very  suitable  to  such  an 
institution  as  Farm  Colony.  If  the  willow  could  be  raised  at  the  Colony,  the 
men  could  be  occupied,  both  in  cultivating,  gathering  and  preparing  the 
willow,  and  in  manufacturing  it. 

The  men  who  are  employed  upon  the  farm  in  the  summer  have  little 
to  do  in  the  winter  unless  special  work  is  provided  for  them.  A  portion 
of  them  can  be  occupied  in  various  constructional  work  about  the  institu- 
tion, but  a  large  number  will  remain  comparatively  idle  unless  special  effort 
is  put  forward  to  provide  a  kind  of  labor  which  they  can  readily  perform. 
It  would  seem  advisable,  therefore,  that  machinery  be  installed  with  which 
these  men  may  work  during  the  winter  season.  Inasmuch  as  these  men 
are  relatively  able-bodied,  the  product  to  be  manufactured  should  be  of  a 
kind  requiring  more  physical  labor  than  the  products  designed  to  be  manu- 
factured at  the  Homes  in  Manhattan  and  Brooklyn. 

(4)  Instructor  in  Industrial  Work 

In  order  to  carry  on  industrial  work  successfully  in  an  almshouse  it  is 
necessary  to  have  one  or  more  instructors,  who  are  not  only  able  to  teach 
the  inmates  how  to  operate  the  machines  and  devices,  but  also  to  supervise 

65 


66  HOSPITAL  COMMITTEE 

them  and  to  see  that  they  are  kept  at  work.  It  would  serve  Httle  purpose  to 
install  machinery  to  be  operated  by  the  inmates  unless  some  competent 
person  be  employed  to  instruct  them  how  to  use  it.  It  is  probable  that  a 
salary  of  $1,200  would  be  sufficient  to  secure  the  services  of  a  man  trained 
to  do  such  work.  If  the  things  to  be  manufactured  are  selected  with  care, 
and  only  those  things  manufactured  which  are  needed  in  City  institutions 
or  departments,  the  product  of  the  labor  of  the  inmates  should  much  more 
than  offset  the  salary  of  the  instructor,  the  interest  on  the  cost,  and  the  up- 
keep, of  the  machinery. 

(S)  Examination  of  the  Farm  at  Farm  Colony  by  the  State  Department  of 
Agricidture 

Chapter  460  of  the  Laws  of  1913  empowers  the  Department  of  Agricul- 
ture to  make  examination  of  almshouse  farms,  and  to  offer  suggestions  with 
regard  to  their  operation.  It  would  seem  highly  advisable  that  New  York 
City  should  avail  itself  of  the  advice  and  services  of  the  Department  of 
Agriculture. 

(6)  Removal  of  Crippled,  Infirm,  and  Senile  from  Farm  Colony 

As  shown  on  page  453,  the  value  of  products  produced  on  the  farm  at 
Farm  Colony  has  decreased  from  $68.52  per  inmate  in  1904,  to  $16.74  in 
1911.  In  1904  there  were  11  employees  connected  with  the  institution 
and  in  191 1  there  were  58.  Although  the  number  of  employees  at  the  in- 
stitution had  increased  fivefold,  the  gross  value  of  farm  products  was  not 
increased,  and  the  value  per  inmate  decreased  over  fourfold.  This  situa- 
tion was  probably,  in  a  measure,  due  to  the  fact  that  a  large  number  of  crip- 
pled, infirm,  and  senile  have  been  sent  to  the  institution.  (See  detailed 
statement  on  page  442.)  The  number  of  inmates  in  1904  was  185,  and  in 
191 1,  703.  Although  the  number  of  inmates  increased  fourfold  between 
these  years,  the  increase  has  been  so  largely  of  the  unproductive  class  that 
the  Colony  farm  has  suft'ered  rather  than  benefited  by  the  additional  number. 

The  presence  of  the  crippled,  infirm,  and  senile  at  the  Colony  not  only 
hinders  the  work  of  the  farm,  but  places  an  additional  burden  upon  the  in- 
stitution in  many  ways.  This  burden  requires  time  and  attention  on  the 
part  of  the  Superintendent,  which  otherwise  could  and  should  be  devoted 
to  the  proper  operation  of  the  farm.  These  inmates  can  be  cared  for  as 
cheaply  on  Blackwell's  Island,  or  in  Brooklyn,  as  at  Farm  Colony.  The 
argument  has  been  put  forward  that,  inasmuch  as  dormitory  accommodations 
exist  at  the  Colony  they  should  be  used,  and  for  that  reason  this  class  of 
inmates  has  been  transferred  from  the  other  two  Homes.  It  has  also  been 
stated  that  the  Manhattan  Home  was  greatly  overcrowded,  and  that  it  has 
been  necessary  to  transfer  many  patients  to  the  Colony.  The  fact  is  that 
the  overcrowding  of  the  Manhattan  Home  during  the  years  191 1  and  1912 
was  due  in  quite  a  measure  to  the  transfer  of  chronic  patients  from  Metro- 
politan and  City  Hospitals  to  the  Home.  These  patients  were  transferred 
for  the  purpose  of  making  room  for  acute  cases  at  these  hospitals.  In 
order,  therefore,  to  increase  the  acute  service  in  Metropolitan  and  City 
Hospitals,  Farm  Colony  has  been  made  to  suffer  by  transferring  to  it  a 
class  of  patients  not  designed  to  be  cared  for  in  that  institution.  But  if 
additional  accommodation  is  needed  for  inmates,  it  would  seem  advisable  to 
provide  for  it  in  connection  with  the  ^Manhattan  or  Brooklyn  Homes,  rather 
than  at  Farm  Colony.    It  is  highly  improbable,  however,  that  additional  bed 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  67 

capacity  will  be  needed  in  these  institutions  if  the  Bureaus  of  admission 
to  the  almshouses  rigorously  examine  all  applicants  and  exclude  those  not 
entitled  to  support  by  the  City.  According  to  that  part  of  this  Report  en- 
titled "Admissions  to  City  Homes,"  fully  20  per  cent,  of  those  admitted 
seem  not  to  be  entitled  to  support  by  the  City,  so  that  a  careful  examination 
of  all  applicants,  and  the  exclusion  of  those  not  entitled  to  support,  will 
probably  provide  all  the  additional  bed  capacity  needed  in  the  near  future. 

(7)  Removal  of  Insane  from  Farm  Colony 

High  class  psychopathic  services  are  provided  at  Bellevue  and  Kings 
County  Hospitals,  where  patients  may  receive  careful  examination  by 
trained  and  competent  alienists.  No  such  service  exists  at  Farm  Colony, 
and  the  small  number  of  insane  on  Staten  Island  would  not  warrant  the 
creation  of  such.  It  seems  unjust  to  the  alleged  insane  on  Staten  Island 
not  to  give  them  the  same  high  class  services  accorded  to  a  like  class  of 
patients  in  Manhattan  and  Brooklyn.  The  Commissioner  of  Charities  has 
the  power  to  transfer  the  patients  at  the  Colony  to  either  of  the  aforesaid 
institutions  for  examination,  and  for  the  welfare  of  such  patients  it  would 
seem  highly  advisable  that  such  action  should  be  taken.  Should  such  a  sys- 
tem be  adopted,  an  alleged  insane  person  would  be  kept  at  the  Colony  but  a 
night  or  a  day,  and  immediately  transferred  to  Bellevue  or  Kings  County 
Hospital.  By  this  method  fewer  attendants  would  be  required  at  the  Col- 
ony; the  alleged  insane  would  be  much  better  cared  for;  and  the  expense 
of  operation  of  the  Colony  would  be  reduced. 


SUMMARY   OF    FINDINGS, 
CONCLUSIONS,   AND   RECOMMENDATIONS 

WITH     REGARD    TO 

THE  OUT-PATIENT  DEPARTMENT  OF 
GOUVERNEUR  HOSPITAL 

A.  Summary  of  Findings: 

1.  The  first  i,ooo  cases  that  came  to  Gouverneur  Out-Patient 
Department  during  the  first  two  weeks  of  January,  1913,  were  taken 
in  order  from  the  registers  of  the  Children's,  General  Medical,  Gy- 
necological, and  Nose,  Throat  and  Ear  Clinics.  Every  one  of  these 
patients  was  visited  at  the  address  given  in  the  books  and  informa- 
tion gathered  regarding  the  home  and  financial  conditions,  number 

,  of  visits  to  Gouverneur  Out-Patient  Department,  result  of  treat- 
ment, and  subsequent  disposition  of  the  case.  Several  days,  at  in- 
tervals during  a  period  covering  three  months,  were  spent  in  observ- 
ing the  conditions  in  the  dispensary  itself.     (Page  459.) 

2.  Many  patients  are  admitted  to  a  clinic  room  at  the  same 
time,  and  when  the  room  is  thus  crowded  the  physician  in  many  in- 
stances makes  no  attempt  to  examine  the  patients,  but  only  pre- 
scribes some  medication  on  the  basis  of  their  reply  to  his  question : 
"What's  the  matter  with  you?"  On  March  15,  1913,  an  investiga- 
tor saw  162  patients  treated  by  two  physicians  in  the  female  medi- 
cal clinic  in  one  hour  and  a  half.  In  the  room  used  as  a  children's 
clinic  (149  sq.  ft.)  another  investigator  counted  36  patients  at  one 
time.     (Page  460.) 

Of  the  63  doctors  and  physicians  comprising  the  staff  of 
Gouverneur  Out-Patient  Department,  46  per  cent,  have  their  private 
offices  located  in  the  neighborhood  of  Gouverneur.  Their  private 
patients  are  drawn,  in  the  main,  from  the  same  district  as  the  dis- 
pensary patients. 

3.  In  14. 1  per  cent,  of  the  cases  the  patients,  when  questioned 
in  their  homes,  stated  that  no  physical  examination  was  given  them. 
The  greatest  percentage  was  in  the  General  Medical  Clinic,  where 
22.6  per  cent,  of  the  cases  had  not  been  examined;  in  the  Gyneco- 
logical Clinic  16.3  per  cent,  of  the  patients  had  not  been  examined. 
(Pages  464,  465,  and  466.) 

In  31.3  per  cent,  of  the  cases  visited  the  patients,  dissatisfied 
with  the  treatment  at  Gouverneur,  had  gone  to  other  dispensaries  or 
to  private  physicians.  In  6.8  per  cent,  of  these  cases  the  patients 
stated  that  the  private  physician  found  the  disease  to  be  different 


HOSPITAL   COMMITTEE 

from  the  diagnosis  of  the  Gouverneur  doctors.  These  alleged  wrong 
diagnoses  involved  cases  of  pneumonia,  scarlet  fever,  and  diph- 
theria.    (Page  466.) 

4.  Cases  of  contagious  and  communicable  diseases  mingle  with 
the  other  patients  in  the  waiting  room  for  long  periods  of  time  be- 
fore examination,  and,  at  times,  after  they  have  been  examined. 
They  are  dismissed  from  the  clinic  rooms  with  the  direction  to  stay 
away  from  the  dispensary  and  to  "go  to  a  doctor."  Of  those  in- 
vestigated, it  was  found  that  in  the  majority  of  cases  the  patients 
were  ui'iaole  to  engage  the  service  of  a  private  physician  and  had 
remained  til  in  the  home  without  any  medical  attention,  with  re- 
sulting danger  of  contagion  to  the  other  members  of  the  family  and 
the  tenement.     (Page  461.) 

5.  The  average  number  of  visits  per  patient  at  the  Gouverneur 
Out-Patient  Department  was  compared  with  the  St.  Bartholomew 
Clinic  of  New  York,  as  follows : 

Average  Number  of  Visits  per 
Clinics  Patient 


General  Medical 

Gynecological 

General  Surgical 

Genito-urinary 

Rectal 

Eye 

Ear 

Nose  and  Throat 

*  Ear,  Nose  and  Throat  are  in  one  clinic  in  Gouverneur  Hospital. 

(Page  463.) 

6.  In  all  the  clinics,  except  the  Tuberculosis  and  Gynecological, 
the  only  data  entered  are  the  name,  age,  address,  and  diagnosis,  and 
when  a  very  busy  period  occurs  even  these  items  are  neglected. 
(Page  462.) 

7.  In  the  four  clinics  investigated,  52.6  per  cent,  of  the  patients 
did  not  return  after  the  first  visit.  Of  those  who  did  not  return, 
44.5  per  cent,  stated  that  they  had  been  benefited  or  cured  by  the 
treatment,  and  55.5  per  cent,  stated  that  they  had  not  been  benefited. 
Of  the  47.4  per  cent,  who  had  made  two  or  more  visits,  13.4  per 
cent,  stated  that  they  had  been  cured  by  the  treatment;  30.6  per 
cent,  were  benefited ;  while  56  per  cent,  believed  themselves  not  to 
have  been  benefited. 

In  the  different  clinics  the  percentage  of  cases  that  had  not 
been  benefited  by  the  treatment  after  repeated  visits,  according  to 
statements  made  by  patients,  ranged  from  41.7  per  cent,  in  the 
Nose,  Throat  and  Ear  Clinics,  to  88. 5  per  cent,  in  the  Gjaiecological 
Clinic.     (Page  466.) 


Gouverneur  St. 

Bartholomew 

U 

3.7 

6.8 

2.3 

5.3 

6.7 

5.5 

14.3 

2.3 

3.3 

6.7 

*(1.7) 

4.2 

FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  71 

B.  Conclusions: 

1.  It  is  evident  that  the  treatment  given  in  the  Out-Patient  De- 
partment of  Gouverneur  Hospital  is  far  from  satisfactory.  This, 
no  doubt,  is  owing  in  quite  a  measure  to  the  cramped  quarters  in 
which  the  Out-Patient  Department  is  operated,  but  with  the  new 
building  which  is  now  being  planned  it  is  hoped  to  obviate  many 
of  the  shortcomings  herein  noted. 

2.  When  the  new  building  is  put  into  use  it  will  be  advisable 
to  entirely  reorganize  the  Out-Patient  Department.  New  forms  of 
records  are  needed;  more  attendants  and  nurses;  a  social  service 
department  should  be  organized;  and  a  larger  proportion  of  at- 
tending physicians  should  be  secured  from  districts  not  served  by 
the  Out-Patient  Department. 

3.  It  will  be  desirable  to  give  the  Out-Patient  Department  a 
better  coordination  and  connection  with  the  hospital,  so  that  there 
may  be  a  freer  interchange  of  patients  between  the  two  departments. 

C.  Recommendations: 

1.  A  new  building  is  to  be  built  for  the  use  of  the  Out-Patient 
Department  of  Gouverneur  Hospital,  plans  for  which  are  now 
being  drawn,  and  this  new  building  will  correct  some  of  the  bad 
conditions  referred  to  in  this  Report.  Before  entering  into  this 
new  building  when  completed  the  Out-Patient  Department  should 
have  a  thorough  reorganization. 

2.  Recommendations  for  the  organization  of  an  Out-Patient 
Department  are  incorporated  in  a  part  of  this  Report  entitled  "Sug- 
gestions for  the  Organization  of  a  Public  Out-Patient  Department" 
(page  469)  ;  and  in  so  far  as  such  general  recommendations  are 
applicable  they  may  be  adopted  in  the  reorganization  plans  of 
Gouverneur  Out-Patient  Department. 


STATEMENT 

WITH  REGARD  TO 

SUGGESTIONS    FOR    THE    ORGANIZATION    OF    A    PUBLIC 
OUT-PATIENT  DEPARTMENT 

The  above  indicated  memorandum  cannot  readily  be  summarized, 
for  the  entire  memorandum  is  primarily  a  recommendation. 

The  fundamental  purpose  of  the  memorandum  is  to  emphasize  the 
importance  of  the  out-patient  department;  to  show  the  number  and  kinds 
of  rooms  that  should  be  provided ;  and  the  character  of  organization  and 
administrative  methods  that  should  prevail. 


n 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,   AND   RECOMMENDATIONS, 

WITH    REGARD   TO 

SICKNESS  IN  THE  HOME  AND  PROPOSED 
HEALTH  CENTER 

A.  Summary  of  Findings : 

1.  The  Committee  made  inquiry  as  to  the  amount  of  sickness 
in  the  home  by  two  methods.  First,  the  number  of  deaths  resuhing 
from  various  diseases  was  ascertained  from  the  records  of  the 
Heahh  Department,  and  the  amount  of  sickness  in  the  home  was 
estimated  by  multiplying  these  ascertained  deaths  by  ratios  estab- 
lished by  leading  medical  authorities — for  purposes  of  brief  de- 
scription this  may  be  designated  as  method  No.  i.  Second,  limited 
and  prescribed  districts  were  selected,  one  in  the  vicinity  of  Riving- 
ton  and  Eldridge  Streets,  on  the  East  Side,  and  the  other  in  the 
vicinity  of  Ninth  Avenue  and  36th  Street,  on  the  West  Side,  and 
by  a  family  to  family  canvass,  information  was  gained  as  to  the 
amount  and  character  of  sickness  and  the  treatment  afforded — this 
may  be  termed  method  No.  2.     (Page  522.) 

2.  By  method  No.  i  it  was  estimated  that  about  89  per  cent,  of 
sickness  was  cared  for  in  the  homes  of  the  East  Side.  Even  in  such 
serious  ailments  as  typhoid  fever,  about  70  per  cent,  of  the  deaths 
took  place  in  the  homes;  84  per  cent,  from  diphtheria;  and  85  per 
cent,  from  pneumonia.  By  method  No.  2  it  was  estimated  that  91.4 
per  cent,  of  the  sickness  was  cared  for  at  home.     (Pages  523  and 

529-) 

3.  By  method  No.  i  it  was  estimated  that  in  the  population  of 
621,339  on  the  lower  East  Side,  during  the  year  1910,  there  were 
3,600,000  days  of  sickness  cared  for  in  the  homes,  as  compared 
with  370,000  days  of  sickness  cared  for  in  hospitals.  In  the  popu- 
lation of  the  West  Side  district,  which  was  about  140,000,  there 
was  a  total  of  about  1,427,000  days  of  sickness  in  the  homes,  and 
but  116,700  days  in  hospitals.     (Pages  523  and  526.) 

4.  About  10.6  per  cent,  of  the  sickness  on  the  East  Side  was 
taken  to  hospitals,  whereas  32.3  per  cent,  was  cared  for  in  dispen- 
saries. Of  those  who  visited  dispensaries,  29  per  cent,  made  but 
one  visit  (page  532).  The  records  of  Gouverneur  Dispensary  in- 
dicate that  over  50  per  cent,  make  but  one  visit.     (Page  468.) 

5.  Of  all  deaths  in  the  East  Side  district,  43  per  cent,  were  of 
children  under  5  years  of  age.    There  were  39,000  cases  of  diar- 

75 


76  HOSPITAL   COMMITTEE 

rhoeal  diseases  among  children,  of  which  but  4,750  were  cared  for 
in  hospitals.     (Page  525.) 

B.  Conclusions: 

I.  A  very  large  proportion  of  all  sickness  is  cared  for  in  the 
home,  and  this  will  contmue  so  because  of  various  considerations. 
If  the  City  is  to  assume  the  responsibility  of  caring  for  sickness 
it  is  imperative  that  there  should  be  some  means  of  securing  fuller 
knowledge  of  home  conditions  which  produce  sickness,  especially 
in  so  far  as  such  home  conditions  may  be  of  a  social  nature  and 
controllable  by  City  regulations. 

2.  The  small  percentage  of  sickness  taken  to  hospitals  and  the 
large  number  of  cases  of  sickness  which  attend  dispensaries  but 
once,  indicate  a  lack  of  confidence  in  municipal  hospitals  and  dis- 
pensaries on  the  part  of  most  of  the  people. 

3.  From  the  investigation  of  sickness  in  the  homes  it  is  evi- 
dent that  the  municipal  hospitals  have  comparatively  little  knowl- 
edge of  the  condition  of  the  homes  from  which  sickness  comes  to 
the  hospitals  or  to  which  convalescent  cases  are  sent. 

C.  Recommendations: 

I.  With  the  purpose  of  more  adequately  caring  for  sickness 
in  the  home,  and  with  the  purpose  of  curing  or  alleviating  many  of 
the  conditions  set  forth  in  this  and  other  sections  of  the  Report, 
the  Committee  suggests  the  establishment  of  an  experimental 
Health  Center,  which  is  described  in  detail,  beginning  on  page  535, 


SUMMARY  OF  FINDINGS, 
CONCLUSIONS,  AND  RECOMMENDATIONS 

WITH  REGARD  TO 

HOSPITAL  HELPERS 

A.  Summary  of  Findings: 

1.  A  large  proportion  of  Hospital  Helpers  are  so-called 
"rounders"  and  "periodic  drunks."  Many  of  them,  however,  are 
capable  and  render  good  service.     (Page  551.) 

2.  The  large  number  of  changes  represent,  in  the  main,  the 
same  personnel,  shifting  from  institution  to  institution.  (Page  558.) 

3.  Raising  of  the  yearly  wage  from  lower  to  higher  grades 
during  the  last  four  years  has  not  increased  the  average  length  of 
stay.     (Page  558.) 

4.  The  eight  lowest  grades,  from  $60  to  $168,  show  about  the 
same  percentage  of  discharges  in  each  of  the  four  years  examined, 
although  the  average  wage  had  been  increased  within  these  grades. 
(Page  558.) 

5.  The  percentage  of  discharges  in  grades  $180  to  $264  in  the 
Department  of  Bellevue  is  as  large  as  the  percentage  of  discharges 
in  the  grades  $60  to  $168  in  the  Department  of  Charities.  The 
average  length  of  stay  in  the  corresponding  grades  is  less  in  these 
upper  grades  in  Bellevue  than  in  the  lower  grades  in  the  Department 
of  Public  Charities.     (Page  561.) 

6.  The  grades  of  Hospital  Helpers  and  titled  positions  overlap. 
The  highest  grade  of  Hospital  Helpers  is  $720;  below  this  highest 
grade  fall  such  titled  positions  as  seamstress,  cook,  barber,  tailor,  etc. 

7.  The  sleeping  quarters  for  Hospital  Helpers  at  Kings  County 
Hospital,  and  Children's  Hospitals  and  Schools,  Randall's  Island, 
are  inadequate  and  undesirable  in  character.     (Pages  565  and  566.) 

8.  The  service  building  at  Metropolitan  Hospital  is  old,  dilapi- 
dated, and  inadequate.     (Page  565.) 

B.  Conclusions: 

1.  The  City  has  assumed  the  support  of  the  indigents;  and,  in 
the  absence  of  other  institutions  wherein  the  periodic  and  semi- 
responsible  drunks  can  live  and  work,  they  can,  to  the  best  advan- 
tage, both  to  themselves  and  to  the  City,  be  supported  as  workers 
in  the  City's  hospitals. 

2.  This  class  renders  good  service  when  sober,  and  is  content 
to  serve  for  a  small  wage. 

17 


78  HOSPITAL   COMMITTEE 

3.  When  the  Hospital  Helper  leaves  the  service  because  of 
drunkenness  it  is  easy  to  fill  his  place,  usually  with  an  experienced 
Helper,  during  about  eight  months  of  the  year.  In  the  sum- 
mer months  there  is  some  scarcity  of  help,  which,  however,  is  not  a 
serious  handicap,  owing  to  the  fact  that  there  are  fewer  admissions 
during  these  months. 

4.  The  lower  grades,  from  $60  to  Si 68  per  year,  act  as  a 
buffer  to  the  higher  grades,  and  when  the  lower  grades  are  abol- 
ished the  same  character  of  Helpers  is  employed  in  the  next  higher 
grades,  without  decreasing  the  percentage  of  discharges  or  increas- 
ing the  constancy  of  service. 

5.  Since  raising  wages  in  the  lower  grades  has  not  increased 
the  length  of  stay  in  the  institutions,  it  is  a  waste  of  money  to  in- 
crease the  wages  of  any  large  proportion  of  the  Helpers  serving  in 
the  lower  grades,  unless  such  increase  abolishes  all  low  grades. 

6.  It  is  the  opinion  of  some  of  the  officials  in  the  hospitals  that 
good  living  and  sleeping  quarters  and  good  food  contribute  largely 
toward  contentment  of  the  workers,  and  that  such  conditions  tend  to 
increase  the  constancy  of  service.  These  opinions  seem  to  be  borne 
out  by  the  fact  that  the  average  length  of  stay  in  Kings  County 
Hospital  is  less  than  in  City  Hospital  or  Metropolitan  Hospital, 
although  the  average  wage  is  larger  in  Kings  County  Hospital  than 
in  these  other  hospitals,  which  have  better  accommodations  for  the 
low-paid  Helpers. 

C.  Recommendations: 

1.  Let  all  employees  receiving  $480  and  below  be  called  Hos- 
pital Helpers.  Let  all  receiving  more  than  this  amount  have  titled 
positions. 

2.  Retain  grades  $120,  $180,  and  $240  until  such  time  as  the 
City  shall  have  accommodation  in  its  Hospital  and  Industrial  Col- 
ony, to  be  established,  for  the  class  of  Hospital  Helpers  who  are 
subject  to  periodical  drunkenness,  and  also  until  such  time  as  the 
City  can  afford  to  pay  a  minimum  wage  of  $240  for  women  and 
$300  for  men. 

3.  Of  the  existing  21  grades  abolish  all  but  the  following: 
$120;  $180;  $240;  $300;  $360;  $420;  $480. 

4.  The  persons  to  be  employed  in  these  grades  and  the  con- 
ditions of  promotion  are  set  forth  in  an  accompanying  Salary  and 
Wage  Schedule. 

5.  Provide  better  living  and  sleeping  quarters  for  Hospital 
Helpers,  especially  at  Kings  County  Hospital,  and  Children's  Hos- 
pitals and  Schools,  Randall's  Island. 


STATEMENT 

WITH    REGARD   TO 

PROPOSED  SALARY  AND  WAGE  SCHEDULE  FOR  THE 
DEPARTMENT  OF  PUBLIC  CHARITIES 

No  summary  has  been  made  of  the  memorandum  bearing  the  above 
title,  since  it  is  solely  the  presentation  of  a  proposed  schedule.  It  is 
based  largely  upon  the  information  gained  in  the  investigation  conducted 
in  connection  Avith  the  report  on  Hospital  Helpers,  which  immediately 
precedes  this. 


79 


SUMMARY  OF  FINDINGS, 
CONCLUSIONS,    AND    RECOMMENDATIONS 

WITH   REGARD  TO 

HANDLING  OF  FOOD  AND  FOOD   WASTE 

A.  Summary  of  Findings: 

Bellevue  and  Allied  Hospitals 

1.  The  amounts  of  the  various  kinds  of  food  used  in  Bellevue 
and  its  allied  hospitals  were  determined  for  the  year  1912.  Con- 
siderable variation  was  found  in  the  amounts  of  like  kinds  of  food 
used  in  the  different  hospitals.  Of  meat,  Bellevue  Hospital  used 
344.8  pounds;  Harlem  Hospital  372.5  pounds;  Gouverneur  Hos- 
pital 319.6  pounds;  and  Fordham  Hospital  393.6  pounds  per  capita 
in  the  year.  Fordham  Hospital  used  84.2  pounds  of  mutton  per 
capita  in  the  year,  as  compared  with  44.  i  pounds  used  by  Gouver- 
neur Hospital.  Of  poultry,  Bellevue  Hospital  used  42  potmds  per 
capita  during  the  year,  as  compared  with  79.5  pounds  used  by  Har- 
lem Hospital,  and  83.4  pounds  used  by  Fordham  Hospital.  The  con- 
sumption of  milk  by  Harlem  Hospital  was  733  pounds,  whereas 
Fordham  Hospital  used  but  547  pounds  per  capita  during  the  year. 
(Page  585.) 

2.  The  requisitions  from  the  allied  hospitals  are  passed  upon 
by  the  Dietitian  at  Bellevue  Hospital  without  a  knowledge  of  the 
number  for  whom  such  food  is  required  in  these  hospitals.  (Page 
586.) 

3.  The  amount  of  food  estimated  for  in  the  budget  of  Bellevue 
Hospital  is  determined  in  the  accounting  department,  without 
consultation  with  the  Dietitian.     (Page  586.) 

4.  The  requisitions  for  food  made  out  by  the  Dietitian  in  Belle- 
vue Hospital  apparently  are  not  based  upon  the  fluctuating  census 
of  the  hospitals.  During  the  first  six  months  of  191 2  the  average 
daily  census  of  patients  was  1,324,  and  the  weekly  issue  of  meat  ^ 
was  4,671  pounds.  During  the  second  six  months  of  the  year  the 
average  daily  census  was  1,171,  while  the  weekly  average  issue  of 
meat  was  4,733  pounds.  Thus,  it  will  be  seen  that  more  meat  was 
used  in  the  gross  during  the  second  half  of  the  year,  although  the 
average  census  was  153  less,  than  during  the  first  half  of  the  year. 

The  average  daily  issue  of  meat  per  patient  during  the  week  end- 
ed April  28,   19 12,  was  .48  pound,  and  approximately  this  same 

'The  term  "meat,"  as  used  in  this  Report,  includes  poultry  and  fish. 

81 


82  HOSPITAL   COMMITTEE 

ratio  was  maintained  in  tlie  months  of  March,  April,  and  May. 
Had  this  ratio  been  maintained  throughout  the  year  Bellevue  Hos- 
pital would  have  used  217,774  pounds  of  meat  for  the  patients,  in- 
stead of  the  244,289  pounds  which  were  actually  issued. 

During  the  months  of  March,  April,  and  May.  1912.  the  average 
census  of  patients  in  Bellevue  Hospital  was  1,337.  During  these 
months  the  average  monthly  issue  of  eggs  was  9,708  dozen.  During 
August,  September,  and  October,  when  the  average  daily  census  of 
patients  was  1,159,  the  average  monthly  issue  of  eggs  was  9,740 
dozen. 

During  1912  Bellevue  Hospital  used  94,926  pounds  of  fowl. 
Of  this,  the  patients  used  approximately  37,540  pounds.  The  re- 
mainder, 57,386  pounds,  was  used  by  officers  and  employees.  The 
average  number  of  employees  was  1,013,  ^"^  of  patients,  1,243. 
(Pages  586  and  587.) 

5.  The  patients  in  Bellevue  Hospital  received,  on  an  average, 
about  one-half  pound  of  meat  per  capita  per  day.  Had  the  officers 
and  employees  consumed  a  pound  of  meat  per  capita  per  day  the 
total  consumption  of  Bellevue  Hospital  for  the  year  1912  would 
have  been  596,682  pounds.  The  actual  issue  was  about  771,075 
pounds.  The  meat  used  for  officers  and  empIo}^ees  in  excess  of  the 
ratio  of  one  pound  per  capita  per  day  cost  approximately  $20,900. 
(Page  587.) 

6.  At  the  request  of  your  Committee,  the  amount  of  waste 
food  returned  from  the  plates  in  four  dining  rooms  at  Bellevue 
Hospital  was  weighed  by  the  employees  in  the  dining  rooms 
during  a  week  in  the  fore  part  of  June,  19 13.  The  waste  in  the 
staff  dining  room  averaged  1.4  pounds  per  capita  per  day,  and  in  the 
Nurses'  Residence  i  pound  per  capita  per  day.  The  highest 
per  capita  waste  in  any  of  the  dining  rooms  at  Kings  Park 
State  Hospital,  where  waste  is  carefully  guarded,  was  .33  pound 
per  day.  The  lowest  per  capita  waste  noted  in  Bellevue  Hospital 
was  .42  pound  per  day,  whereas  the  average  per  capita  waste  in 
Kings  Park  State  Hospital  was  .23  pound  per  day.     (Page  589.) 

7.  x\n  employee  of  your  Committee,  during  the  latter  part  of 
July  and  the  fore  part  of  August,  1913,  separated  the  waste  returned 
from  the  plates  after  each  meal  in  the  staff  dining  room  and  in  the 
dining  room  of  the  Nurses'  Residence  during  a  period  of  six  days. 
As  a  result  of  this  careful  analysis  of  the  waste  it  was  found  that 
in  the  staff  dining  room,  which  fed  oti  an  average  about  200  daily, 
the  total  waste  of  meat  alone  was  about  230  pounds.  On  one  day 
25  pounds  of  porterhouse  steak  were  returned  with  the  plates,  and, 
at  the  same  time,  38  pounds  remained  in  the  pantry,  cooked  but  not 
served.  The  average  daily  waste  of  food  returned  from  the  plates 
in  this  dining  room  was  215  pounds. 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  83 

The  dining  room  in  the  Nurses'  Residence  serves  approxi- 
mately 350  persons  per  meal.  During  the  six  days  in  which  the 
waste  was  segregated  by  an  employee  of  your  Committee  the  total 
waste  of  meat  returned  from  the  plates  was  285  pounds.  On  one 
day  89  pounds  of  steak  and  chicken  were  returned,  and  on  another 
day  55  pounds  of  Irish  stew  and  veal  were  returned.  The  average 
daily  waste  of  all  foods  returned  from  the  plates  was  281  pounds. 
(Pages  587  to  594.) 

Department  of  Public  Charities 

1.  According  to  the  Storehouse  records  Metropolitan  Hos- 
pital received  431,000  pounds  of  beef  during  the  year  191 1.  Ac- 
cording to  the  distribution  records  of  the  Dietitian,  the  butcher 
delivered  to  the  kitchen  311,000  pounds,  which  indicates  an  unac- 
counted for  difference  of  27  per  cent.     (Page  595.) 

2.  The  delivery  records  in  Kings  County  Hospital  were  checked 
for  the  first  week  in  January,  19 12.  According  to  the  Dietitian's 
records  the  kitchen  received  3,422  pounds  of  beef,  bone,  and  stock. 
According  to  the  delivery  records  of  the  butcher  he  sent  to  the 
kitchen  during  this  same  period  4,051  pounds.  There  seemed  to 
have  been  no  knowledge  of  the  discrepancy  between  these  two  sets 
of  records,  and  no  attempt  to  reconcile  them.     (Page  595.) 

3.  In  the  State  hospitals  for  the  insane  there  is  not  more 
than  2  per  cent,  variation  between  the  records  of  the  amount  re- 
ceived by  the  butcher  and  the  amount  delivered  to  and  receipted  for 
by  the  kitchens.     (Page  596.) 

4.  The  gross  amount  of  all  kinds  of  food  used  by  the  different 
hospitals  in  the  Department  of  Public  Charities  varies  markedly. 
Kings  County  Hospital  used  1,376  pounds  of  food  per  capita  per 
year,  as  compared  with  1,649  ^^  City  Hospital,  and  1,722  in  Metro- 
politan Hospital.     (Page  597.) 

5.  The  difference  in  the  gross  amounts  of  food  used'  in 
the  different  hospitals  also  represented  a  difference  in  the  amount 
of  food  elements ;  viz.,  protein  and  calories.  Kings  County  Hos- 
pital used  food  containing  on  an  average  108  grams  of  protein  per 
capita  per  day,  as  compared  with  138  in  City  Hospital  and  143  in 
Metropolitan  Hospital,  while  Bradford  Street  Hospital  used  162. 
The  calories  contained  in  the  food  used  in  Kings  County  Hospital 
amounted  to  3,021;  in  City  Hospital  3,820;  in  Metropolitan  Hos- 
pital 3,795.     (Page  597-) 

6.  Metropolitan  and  City  Hospitals  used  more  beef  during 
the  summer  months,  when  fresh  vegetables  were  abundant,  than 
during  the  winter  months,  when  vegetables  are  obtainable  only  in 
dried  or  canned  forms.  The  average  daily  per  capita  consumption 
of  beef  in  City  Hospital  in  the  six  months  ended  March,  191 1,  was 


84  HOSPITAL   COMMITTEE 

.48  pound,  and  in  the  following  six  months  .485  pound.  In  Metro- 
politan Hospital  it  was  .515  pound  in  the  winter  months  and  .55 
pound  in  the  summer  months.     (Page  598.) 

7.  The  patients  in  the  hospitals  of  the  Department  of  Public 
Charities  received  more  food  per  capita  per  year  than  the  inmates 
of  the  State  insane  asylums.  The  average  consumption  in  five  of 
the  large  State  hospitals  for  the  insane  during  the  year  1910  was 
1,236  pounds.  The  average  issue  in  the  hospitals  of  the  De- 
partment of  Public  Charities  for  the  year  191 1  was  1,605  pounds. 
(Page  598.) 

Department  of  Health 

I.  A  marked  variation  was  noted  in  the  per  capita  amount  of 
food  used  in  the  different  hospitals  of  the  Department  of 
Health.  Willard  Parker  Hospital  and  Kingston  Avenue  Hospital 
care  largely  for  the  same  class  of  patients.  Willard  Parker  Hospital 
used,  during  the  year  1912,  1,655  pounds  of  food  per  capita,  while 
Kingston  Avenue  Hospital  used  but  1,371  pounds  per  capita.  In  the 
amount  of  food  supplied  at  Willard  Parker  Hospital  there  were 
116  grams  of  protein  per  capita  per  day  and  3,205  calories.  In  the 
food  supplied  at  Kingston  Avenue  Hospital  there  were  87  grams 
of  protein  per  capita  and  2,578  calories. 

The  Sanatorium  at  Otisville,  which  cares  exclusively  for  tuber- 
culous patients,  used  2,447  pounds  of  food  per  capita,  whereas 
Riverside  Hospital,  which  cares  for  both  tuberculous  patients  and 
some  patients  of  mixed  contagions,  used  2,207  pounds  per  capita. 
Tuberculous  patients  are  supposed  to  be  fed  on  a  heavy  meat  diet. 
These  patients  at  Otisville  received  573  pounds  of  meat  per  capita 
during  the  year.  The  tuberculous  patients  at  Riverside  Hospital, 
including  some  cases  of  mixed  contagion,  received  464  pounds  of 
meat  per  capita.     (Pages  600  and  601.) 

B.JConclusions : 

BcUcvue  and  Allied  Hospitals 

1.  The  difference  in  the  amount  of  food  used  in  the  dif- 
ferent hospitals  of  the  Department  of  Bellevue  indicates  a  lack  of 
proper  supervision  of  the  distribution  of  food  from  the  central 
storehouse  to  the  allied  hospitals.  The  distribution  to  these  hos- 
pitals cannot  be  properly  regulated  without  a  determination  of  the 
per  capita  amount  of  each  kind  of  food  which  these  hospitals  should 
receive,  accompanied  by  a  daily  accounting  of  the  amount  sent  to 
these  hospitals  and  the  amount  remaining  to  their  credit.  A  close 
supervision  of  this  general  character  has  not  been  exercised  by  the 
officers  at  Bellevue  Hospital. 

2.  The  failure  to  adjust  the  daily  distributions  of  food  in 
Bellevue  Hospital  to  the  varying  number  of  patients  and  employees 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  85 

has  resulted  in  either  an  underfeeding  in  certain  seasons,  or  over- 
feeding in  other  seasons,  or  a  waste  of  food.  The  per  capita  distri- 
bution of  food  in  the  months  when  the  census  was  largest  was  prob- 
ably sufficient,  judging  by  the  gross  amount  distributed.  This  leads 
to  the  conclusion  that  in  other  portions  of  the  year  the  patients  were 
overfed,  or  that  a  portion  of  the  food  was  wasted. 

3.  The  amount  of  meat  served  to  the  patients  in  Belle vue  is 
sufficient,  but  the  amount  served  to  the  officers  and  employees  is 
excessive  and  accompanied  by  a  marked  waste. 

4.  The  waste  of  food  in  the  kitchens  examined  seemed  to  be 
due  to  (a)  requisitioning  more  than  was  needed;  (b)  the  prepara- 
tion of  all  food  requisitioned  without  regard  to  the  number  to  be 
served;  (c)  the  preparation  and  serving  of  excessively  large  indi- 
vidual portions;  and  (d)  the  serving  of  all  plates  in  the  pantry  with 
equal  portions,  irrespective  of  the  personal  tastes  of  those  served. 

5.  Although  gross  waste  has  been  noted  in  connection  with  the 
handling  of  food  in  Bellevue  Hospital,  the  Superintendent  and  other 
officers  of  Bellevue  are  not  subject  to  censure,  owing  to  the  fact  that 
the  hospital  is  undermanned  and  the  officers  are  charged  with  more 
duties  than  they  can  properly  perform,  and  also  because  of  the  fact 
that  successful  methods  of  controlling  waste  in  large  institutions 
have  but  recently  been  developed. 

The  Department  of  Bellevue  has  but  two  administrative  officers. 
The  Superintendent  and  the  Assistant  Superintendent  of  Bellevue 
are  charged,  not  only  with  the  supervision  of  Bellevue  Hospital, 
but  also  that  of  the  three  allied  hospitals.  The  supervision  of  the 
operation  of  Bellevue  Hospital  alone  is  a  task  of  sufficient  propor- 
tions to  require  the  entire  time  of  a  superintendent  and  an  assistant 
superintendent,  and  it  is  exceedingly  difficult  for  two  such  officers 
to  properly  handle  the  many  problems  that  arise  in  connection  with 
the  allied  hospitals.  It  is  highly  probable  that  marked  economies 
could  be  secured  in  the  Bellevue  Department  if  additional  supervis- 
ing force  were  provided. 

Department  of  Public  Charities 

1.  The  gross  amount  of  meat  received  by  the  butcher  at  an  in- 
stitution should  not  exceed  the  net  amount  of  meat,  bone,  and  stock 
delivered  to  the  kitchens  by  more  than  2  per  cent.  This  2  per  cent, 
will  account  for  all  necessary  waste  in  trimming  and  shrinkage. 

2.  There  has  been  no  apparent  efifort  in  the  institutions  of  the 
Department  of  Charities  to  reconcile  the  records  of  the  Dietitians  of 
meat  delivered  to  the  kitchens  with  the  records  of  the  Storehouse 
of  meat  delivered  to  the  institutions.  The  failure  to  reconcile 
such  accounts  has  left  the  way  clear  for  all  sorts  of  waste  and  irregu- 
larities. 


86  HOSPITAL   COMMITTEE 

3.  The  large  percentage  of  difference  between  the  gross  amount 
of  meat  received  by  the  butcher  and  the  amount  requisitioned  by 
the  Dietitian  noted  in  connection  with  Metropolitan  and  Kings 
County  Hospitals  indicates  a  lax  system  of  accounting,  and  a  lack 
of  appreciation  of  the  necessity  of  closely  regulating  the  distribu- 
tion of  food. 

4.  The  greater  use  of  meat  in  the  summer  than  in  the  winter 
noted  in  connection  with  some  of  the  hospitals  of  the  Department 
of  Charities  indicates  that  the  Department  has  not  maintained  a 
definite  per  capita  allowance,  and  has  not  taken  into  consideration 
the  fact  that  less  meat  is  needed  in  hot  weather  than  in  cold. 

5.  The  marked  difference  in  the  supply  of  food  per  capita 
in  the  different  hospitals  of  the  Department  of  Charities  indi- 
cates that  little  attempt  is  made  to  equalize  the  food  consumption 
in  the  different  institutions,  and  that  no  recognized  standard  of 
feeding  is  followed. 

6.  The  administrative  officials  in  the  Department  of  Public 
Charities  consist  of  the  Commissioner  of  Charities :  two  Deputy 
Commissioners,  connected  with  the  central  office  in  Manhattan ;  one 
Deputy  Commissioner,  in  Brooklyn ;  a  General  Medical  Superintend- 
ent; and  a  Departmental  Dietitian.  If  the  duties  of  these  various 
officers  were  properly  distributed  and  apportioned  there  would  seem 
to  be  no  reason  why  the  handling  of  supplies  in  the  Department 
should  not  be  efficiently  performed  and  adequately  checked.  The 
facts  indicate,  however,  that  either  the  duties  have  not  been  properly 
distributed,  or  there  has  been  a  neglect  to  perform  the  functions 
assigned. 

Department  of  Health 

I.  The  noteworthy  difference  in  the  supply  of  food  per  cap- 
ita in  Kingston  Avenue  Hospital  and  \A^illard  Parker  Hospital 
indicates  a  lack  of  standard  for  the  proper  feeding  of  patients.  The 
fact  that  Riverside  Hospital,  which  cares  for  tuberculous  patients 
and  some  cases  of  mixed  contagion,  uses  considerably  more  food  per 
capita  than  the  Otisville  Sanatorium,  which  cares  for  tuberculous 
patients  only,  indicates  that  insufficient  attention  has  been  given  to 
the  proportions  of  food  needed  by  different  classes  of  patients. 

The  above  conclusions  are  based  on  the  food  records  of  the 
Department  for  the  year  1912.  The  findings  of  the  Committee 
were  placed  in  the  hands  of  the  Commissioner  of  Health  early  in 
the  year  1913,  and  the  irregular  distribution  and  consumption  of 
food  noted  in  this  report  have  been,  in  a  large  measure,  corrected. 

C.  Recommendations: 

Bellci'ue  and  Allied  Hospitals 

I.  The  Dietitian  should  be  made  responsible  for  determining 
the  total  amount  of  the  variouskinds  of  food  needed  for  theHospital. 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  87 

2.  The  Dietitian  should  requisition  all  food  on  the  basis  of  an 
actual  count  of  both  patients  and  employees,  and  the  amount  requi- 
sitioned for  any  particular  day  should  be  based  upon  the  actual  count 
on  the  second  day  preceding  the  day  on  which  such  requisitions  are 
issued. 

3.  A  per  capita  allowance  of  each  kind  of  food  should  be  estab- 
lished for  patients  and  officers  and  employees.  The  aggregate 
amount  of  each  article  of  food  needed  for  the  year  should  be  based 
upon  the  daily  per  capita  allowance.  The  requisitions  should  ad- 
here strictly  to  the  established  allowances,  and  should  be  made  to 
apply  to  the  allied  hospitals  as  well  as  to  Bellevue  Hospital. 

'4.  A  basic  dietary  table  similar  to  that  recommended  on  page 
606  should  be  established,  and,  in  connection  therewith,  a  system 
of  separating  and  weighing  waste  similar  to  that  described  on  pages 
603  to  605  should  be  installed.  The  basic  dietary  table  should  be 
corrected  from  time  to  time,  according  to  the  finding  of  waste  of 
the  various  articles  of  food. 

5.  A  business  manager  should  be  provided  for  the  Department 
of  Bellevue.  The  function  of  such  manager  should  be  to  determine 
the  kinds,  causes,  and  amounts  of  supplies  to  be  used,  and  to  super- 
vise their  distribution  and  consumption.  He  should  also  have  su- 
pervision of  the  care  of  the  buildings  and  the  employment  of 
the  help,  and  perform  the  functions  of  the  former  purchasing 
agent.  His  salary  should  be  not  less  than  $4,000  a  year  and  main- 
tenance. 

6.  A  schedule  of  the  yearly  per  capita  proportions  of  food 
for  use  in  general  hospitals  is  set  forth  on  page  608.  It  is  recom- 
mended that  this  be  adopted  as  a  basis  for  estimating  the  amounts 
of  the  various  kinds  of  food  needed  for  the  year. 

7.  A  monthly  statement  similar  to  that  shown  opposite  page  610 
should  be  placed  before  the  Superintendent  of  each  institution  and 
the  General  Superintendent,  to  inform  them  as  to  the  proportions 
of  the  various  kinds  of  food  that  are  being  used;  the  proportion  of 
the  budget  allowance  that  has  been  consimied;  and  the  amounts  of 
food  elements  that  have  been  supplied. 

8.  If  the  above  recommendations  are  put  into  effect  the  saving 
in  food  cost  alone  in  the  Department  of  Bellevue  should  be  not  less 
than  $30,000  a  year,  compared  with  the  cost  in  1912. 

Department  of  Public  Charities 

I.  The  Dietitian  should  determine  the  average  percentage  of 
fat,  bone,  and  trimmings  that  should  be  cut  out  of  each  carcass  by 
the  butcher  in  cutting  up  the  carcass  for  delivery.  Memoranda 
should  be  kept  to  see  that  these  proportions  are  adhered  to. 


HOSPITAL   COMMITTEE 

2.  The  distribution  records  for  meat  should  be  recapitulated  not 
less  than  once  a  week,  and  placed  in  the  hands  of  the  Dietitian  for 
comparison. 

3.  There  should  be  no  substitution  of  meats  for  the  specific 
kind  ordered  by  the  kitchen,  except  by  order  of  the  Dietitian  author- 
izing such  substitution,  which  substituted  order  should  be  entered  in 
the  records. 

4.  The  supervising  Dietitian  should  be  made  responsible  for 
determining  the  total  amounts  of  the  various  kinds  of  food  needed 
for  each  hospital  and  for  each  almshouse.  These  amounts  should 
be  based  upon  established  schedules.  It  is  recommended  that  a 
schedule  similar  to  that  set  forth  on  page  608  be  adopted  for  the 
general  hospitals,  and  that  the  schedule  set  forth  on  page  609  be 
adopted  for  the  almshouses. 

5.  The  Dietitian  should  requisition  all  food  on  the  basis  of  an 
actual  count  of  both  patients  and  employees,  and  the  amount  requi- 
sitioned for  any  particular  day  should  be  based  upon  the  actual 
count  on  the  second  day  preceding  the  day  on  which  such  requisitions 
are  issued. 

6.  A  basic  dietar}^  table  similar  to  that  recommended  on 
page  606  should  be  established,  and,  in  connection  therewith,  a  sys- 
tem of  separating  and  weighing  waste  similar  to  that  described  on 
pages  603  to  605  should  be  installed.  The  basic  dietary  table  should 
be  corrected  from  time  to  time,  according  to  the  finding  of  the 
amount  of  waste  of  the  various  articles  of  food. 

7.  A  monthly  statement  similar  to  that  shown  opposite  page  610 
should  be  placed  before  the  Superintendent  of  each  institution  and 
before  the  Commissioner  of  Charities,  to  inform  them  as  to  the 
proportions  of  the  various  kinds  of  food  that  are  being  used ; 
the  proportion  of  the  budget  allowance  that  has  been  consumed; 
and  the  amounts  of  food-elements  that  have  been  supplied. 

8.  If  the  above  recommendations  are  put  into  effect  the  saving 
in  meat  cost  alone  in  the  hospitals  of  the  Charities  Department 
should  be  not  less  than  $13,000  per  year,  compared  with  the  cost  in 
1912. 

Department  of  Health 

I.  It  is  recommended  that  the  Department  of  Health  use  a 
schedule  similar  to  that  set  forth  on  page  608  as  a  basis  for  the 
budgetary  estimate  of  food  needed  for  an  ensuing  year  in  each 
of  the  institutions  caring  for  cases  of  mixed  contagion,  and  also 
for  institutions  caring  for  tuberculous  patients.  This  schedule  is 
submitted  only  as  tentative,  and  should  be  modified  by  the  experi- 
ence of  the  Department,  after  careful  study  of  the  needs  of  each 
class  of  patients. 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  89 

2.  A  basic  dietary  table  similar  to  that  recommended  on  page 
606  should  be  established,  and,  in  connection  therewith,  a  system 
of  separating  and  weighing  waste  similar  to  that  described  on  pages 
603  to  605  should  be  installed.  The  basic  dietary  table  should  be 
corrected  from  time  to  time,  according  to  the  finding  of  the  amount 
of  waste  of  the  various  articles  of  food. 

3.  A  monthly  statement  similar  to  that  shown  opposite  page  610 
should  be  placed  before  the  Superintendent  of  each  institution  and 
before  the  Commissioner  of  Health,  to  inform  them  as  to  the  pro- 
portions of  the  various  kinds  of  food  that  are  being  used ;  the  pro- 
portion of  the  budget  allowance  that  has  been  consumed;  and  the 
amounts  of  food-elements  that  have  been  supplied. 


SUMMARY   OF   FINDINGS, 
CONCLUSIONS,   AND   RECOMMENDATIONS 

WITH   REGARD  TO 

CHARACTER  AND   COSTS   OF  HOSPITAL  BUILDINGS 

A.  Sixmmary  of  Findings : 

1.  The  figures  of  cost  of  most  of  the  newer  hospital  buildings 
were  ascertained  by  the  Committee  from  accounts  and  vouchers  in 
the  Comptroller's  department.  With  the  total,  cost  of  each  known, 
the  costs  per  cubic  foot,  per  square  foot,  per  bed,  etc.,  were  ascer- 
tained. The  buildings  of  like  character  were  then  compared,  one 
with  another,  and  also  with  a  building  selected  or  designed  as  a 
standard.     (Page  657.) 

2.  The  cost  per  bed  of  the  Nurses'  Home  at  Kingston  Avenue 
Hospital  was  $1,190,  whereas  the  Nurses'  Home  at  Metropolitan 
Hospital  cost  $2,157  P^r  bed.  The  Nurses'  Home  at  Kings  County 
Hospital  cost  29  cents  per  cubic  foot,  while  at  Sea  View  Hospital 
the  cost  was  44.8  cents  per  cubic  foot.  Though  there  was  this 
marked  difference  in  the  cubic  foot  cost  of  these  two  buildings,  the 
cost  per  bed  was  nearly  the  same — for  Kings  County  Hospital 
Nurses'  Home  $1,747,  and  for  Sea  View  Hospital  Nurses'  Home 
$1,820.  This  is  due  to  the  fact  that  there  is  an  allowance  of  6,000 
cubic  feet  of  space  per  nurse  in  Kings  County  Hospital,  whereas 
the  allowance  in  the  Sea  View  Home  is  but  4,050.     (Page  662.) 

3.  The  amount  of  space  provided  in  general  rooms  for  the 
nurses  ranges  from  26  square  feet  per  nurse  in  the  Nurses'  Home 
at  Riverside  Hospital  to  54  square  feet  in  the  Home  at  Kings 
County  Hospital.     (Pages  661  to  664.) 

4.  The  cost  per  bed  for  dormitories  ranged  from  $633  for  the 
Dormitory  at  Willard  Parker  Hospital  to  $1,202  for  the  Dormitory 
for  Female  Help  at  Metropolitan  Hospital.  This  contrast  is  partly 
due  to  the  difference  between  the  costs  per  cubic  foot,  which  were 
27.5  cents  for  the  Dormitory  at  Willard  Parker  Hospital  and  32.6 
cents  for  the  Dormitory  at  Metropolitan  Hospital.  The  chief  dif- 
ference, however,  is  in  the  amount  of  space  allowed  per  bed,  being 
but  2,300  cubic  feet  in  the  former  and  3,680  cubic  feet  in  the 
latter. 

The  Dormitory  for  Male  Help  at  Bellevue  Hospital  cost  41  cents 
per  cubic  foot,  while  the  cost  per  bed  was  but  $1,186.  This  com- 
paratively low  cost  per  bed  is  due  to  the  large  number  of  beds  in 
each  room. 

91 


92  HOSPITAL   COMMITTEE 

The  Male  Help  Dormitory  as  planned  for  the  new  Greenpoint 
Hospital  appears  to  provide  4,125  cubic  feet  per  bed,  which  seems 
to  be  twice  the  number  of  cu])ic  feet  necessary.  (Pages  667  to 
670.) 

5.  The  height  of  floors  in  all  of  the  dormitory  buildings  seems 
to  be  greater  than  necessary.  The  lowest  found,  11  feet,  is  in  the 
Dormitor}^  for  Female  Help  at  City  Hospital.  The  highest  is  in 
Bellevue,  where  one  story  is  19  feet  8  inches,  and  the  other  stories 
are  15  feet  or  more.     (Pages  668  and  66g.) 

6.  The  cost  per  bed  for  pavilions  housing  tuberculous  patients 
of  a  nearly  like  cost  per  cubic  foot  was  $657  for  a  pavilion  at  River- 
side Hospital  and  $1,180  at  Sea  View  Hospital.  These  figures  are 
for  the  pavilions  considered  by  themselves,  and  not  the  additional 
cost  of  auxiliary  buildings.  The  cost  per  cubic  foot  of  these  two 
buildings  was  34.1  cents  for  the  Health  Department  pavilion  and 
35.5  cents  for  the  Sea  View  building.  The  difference  in  the  cost 
per  bed  was  due  to  the  planning  of  the  buildings.  (Pages  676  to 
678.) 

7.  The  ward  buildings  in  connection  with  the  general  hospitals 
were  found  to  vary  in  the  matter  of  cost,  from  $855  per  bed  for  the 
new  wing  at  Kings  County  Hospital  to  $1,890  for  Pavilions  A  and 
B  of  Bellevue  Hospital.  According  to  the  plans  now  drawn  it  seems 
probable  that  the  cost  per  bed  in  Greenpoint  Hospital  will  be  $2,300. 
These  costs  are  only  of  the  ward  buildings,  considered  as  units. 
The  cost  per  cubic  foot  ranges  from  28.4  cents  for  the  new  wing  of 
Kings  County  Hospital  to  41.6  cents  for  Pavilions  A  and  B,  and 
36.7  cents  for  Pavilions  L  and  M,  of  Bellevue  Hospital.  (Pages 
670  to  675.) 

8.  Many  of  the  newer  buildings  of  the  Departments  of  Health, 
Charities,  and  Bellevue  and  Allied  Hospitals  were  examined  by  Ed- 
ward F.  Stevens,  of  Boston.  He  especially  commends  the  buildings 
of  the  Health  Department,  the  tuberculosis  pavilions  of  Metropoli- 
tan Hospital,  the  new  wing  and  children's  pavilion  of  Kings  County 
Hospital,  and  the  new  pavilions  under  construction  at  Bellevue  Hos- 
pital.    His  criticisms  in  the  main  are  as  follows : 

(a)  Lack  of  utility  rooms  and  clothes  closets  in  connection 
with  Riverside  Hospital  pavilion. 

(b)  Excessive  height  of  ceilings  in  the  scarlet  fever  pavilion 
at  Willard  Parker  Hospital. 

(c)  Sea  View  Hospital:  location  of  the  power  plant  on  the 
side  whence  the  prevailing  winds  come;  semicircular  ground  plan, 
not  providing  best  exposure ;  insufficient  bathing  facilities ;  too  many 
hj'dro-therapeutic  rooms;  lack  of  lockers  for  clothes;  excess  of 
sterilizers;  unnecessarily  expensive  medicine  closets;  costly  charac- 
ter of  linen  closets;  floors  with  many  cracks,  making  it  difficult  to 
keep  them  sanitary;  surgical  building  unnecessarily  expensive  and 


FINDINGS,   CONCLUSIONS   AND   RECOMMENDATIONS  93 

elaborate;  and  buildings  so  planned  as  to  require  a  large  number  of 
elevators. 

(d)  In  nearly  all  buildings  of  all  hospitals:  too  many  lights 
badly  located;  with  lack  of  proper  control,  owing  to  regulations  of 
the  Department  of  Water  Supply,  Gas,  and  Electricity. 

(e)  In  the  pavilions  at  Bellevue :  insufficient  number  of  win- 
dows ;  unnecessarily  heavy  woodwork ;  excessive  height  of  ceilings ; 
radiators  of  a  type  not  readily  cleaned  ;  insufficient  elevators ;  plumb- 
ing fixtures  too  complicated.     (Pages  640  to  646.) 

Conclusions : 

1.  The  hospital  buildings  have  been  economically  built  from 
the  standpoint  of  cost  per  cubic  foot,  but  insufficient  care  has  been 
given  to  planning  and  to  the  handling  of  details. 

2.  Some  of  the  nurses'  homes  have  provided  an  excessive  area 
of  general  rooms,  and  larger  rooms  than  necessary  for  the  nurses' 
bedrooms.     Such  planning  increases  the  cost  per  bed  unnecessarily. 

3.  It  seems  inadvisable  to  attempt  to  economize  in  building 
dormitories  for  help  by  providing  only  open  dormitory  rooms.  Sep- 
arate rooms  will  secure  and  retain  a  better  class  of  help.  In  most 
cases,  where  such  rooms  have  been  provided,  they  have  been  made 
too  large,  thereby  increasing  the  cost  per  bed  unnecessarily. 

4.  More  consideration  should  be  given  to  the  use  to  which  an 
institution  or  a  building  is  to  be  put  before  planning  such  institution 
or  building.  Sea  View  Hospital  when  completed  will  cost  over 
$4,000  per  bed,  whereas,  even  for  second  stage  cases,  the  institu- 
tion, if  it  had  been  properly  planned,  should  not  have  exceeded 
$2,000  per  bed.  If  it  was  the  intention  to  use  the  institution  for 
incipient  cases  the  cost  should  not  have  exceeded  from  $1,000  to 
$1,500  per  bed.  It  would  seem,  therefore,  that  if  the  institu- 
tion had  been  more  simply  planned,  at  least  2,000  beds  could  have 
been  arranged  for  at  Sea  View  instead  of  the  1,000  which  have 
been  provided.  The  cost  per  bed  of  New  York  State  Hospital  for 
Treatment  of  Incipient  Pulmonary  Tuberculosis,  at  Raybrook,  was 
$1,500,  and  for  the  Boston  Consumptives'  Hospital,  at  Mattapan, 
Massachusetts,  it  was  $1,250. 

If  New  York  City  is  to  provide  institutional  care  for  a  large 
proportion  of  the  tuberculosis  cases  now  cared  for  at  home,  the  in- 
stitutions for  such  purpose  must  be  built  upon  plans  much  simpler 
than  those  provided  for  Sea  View  Hospital.  The  Department  of 
Health  is  establishing  standards  which  are  very  satisfactory. 

5.  The  subordination  of  the  interior  arrangements  of  the  Belle- 
vue buildings  to  exterior  architectural  symmetry  has  resulted  in 
excessive  cost,  inconvenience,  and  bad  lighting.  It  seemed  advisable 
to  the  original  planners  of  the  first  ward  buildings  at  Bellevue  to 


94  HOSPITAL   COMMITTEE 

make  the  first  story  iS  feet  6  inches  in  height  and  all  of  the  other 
stories  15  feet.  Because  the  first  building  was  planned  and  built 
with  these  dimensions  it  has  seemed  to  the  management  advisable 
and  necessary  to  continue  on  the  original  lines.  If  the  Dormitory 
plans  had  not  followed  these  original  ideas  at  least  two  additional 
floors  could  have  been  incorporated  in  the  Dormitory  building  with- 
out increasing  its  height.  The  excess  height  of  the  ceilings  has 
needlessly  cost  Bellevue  many  thousands  of  dollars. 

For  the  sake  of  economy  in  the  construction  of  future  buildings 
at  Bellevue  serious  consideration  should  be  given  to  the  advisability 
of  reducing  the  height  of  ceilings  and  adjusting  the  height  of  each 
floor  to  its  appropriate  use. 

6.  The  buildings  connected  with  the  institutions  of  the  Depart- 
ment of  Health  give  evidence  of  very  careful  planning.  Economy 
has  been  secured,  both  in  plans  and  material,  and  at  the  same  time 
the  welfare  of  the  patients  has  not  been  sacrificed. 

7.  It  is  unfortunate  that  the  Department  of  Water  Supply,  Gas, 
and  Electricity  has  power  to  dictate  the  kind  and  location  of  lights 
in  hospital  buildings.  This  is  a  matter  of  technical  knowledge  which 
such  a  department  is  not  supposed  to  have  and  does  not  have.  The 
Department's  orders  have  resulted  in  very  faulty  and  uneconomical 
lighting. 

C.  Recommendations: 

1.  The  plans  of  every  hospital  building  should  be  submitted  to 
one  or  more  hospital  experts  for  review  and  suggestion. 

2.  Only  hospital  architects  who  have  demonstrated  their  abil- 
ity to  plan  economical  hospitals  should  be  employed. 

3.  Before  any  hospital  building  is  planned  buildings  of  a  simi- 
lar character  in  New  York  City  and  elsewhere  should  be  studied 
for  the  best  ideas  as  to  possible  economies  and  improvements.  The 
tables  accompanying  this  report  should  be  of  value  in  such  a  study. 
Suggestions  as  to  plans  for  an  out-patient  department  are  set  forth 
in  a  section  of  this  Report  dealing  with  the  out-patient  department. 

4.  Every  building  should  be  located  and  designed  with  a  view 
to  reducing  its  operating  cost  to  as  low  a  point  as  possible.  The 
operating  costs  have  been  very  little  considered  in  planning  such  an 
institution  as  Sea  View  Hospital. 

5.  The  demand  for  beds  in  public  hospitals  in  New  York  City 
is  so  great  that  every  reasonable  effort  should  be  put  forth  by  the 
officers  of  each  department  when  planning  buildings  to  so  design 
them  as  to  arrangement  and  material  that  the  largest  number  of 
beds  possible  may  be  provided  for  the  least  expenditure  for  con- 
struction and  subsequent  operation. 


STATEMENT 

WITH   REGARD   TO 

INTERNAL  CONTROL  FORMS   SUGGESTED 
FOR  BELLEVUE  HOSPITAL 

No  summary  has  been  made  of  the  above  entitled  memorandum, 
since  forms  cannot  well  be  summarized.  The  memorandum  presents 
forms  suggested  for  purposes  for  which  no  forms  are  now  used  and  also 
as  substitutes  for  some  of  the  forms  in  present  use.  The  real  purpose 
of  the  memorandum  is  to  emphasize  the  importance  of  an  adequate 
system  of  reports  from  subordinates  to  the  superintending  head  of  the 
Hospital. 


95 


STATEMENT 

WITH    REGARD   TO 

PROPOSED   REORGANIZATION   OF  THE  MEDICAL 
SERVICE  IN  BELLEVUE  HOSPITAL 

The  memorandum  bearing  the  above  title  has  not  been  summarized, 
since  it  is  both  a  recommendation  and  a  plan  for  the  reorganization  of 
the  medical  and  surgical  service  of  Bellevue  Hospital.  Any  attempt 
to  present  a  summary  would  be  wholly  inadequate  and  of  little  value. 


STATEMENT 

WITH    REGARD   TO 

SOME  PROBLEMS  COMMON  TO  ALL 
THE  DEPARTMENTS 

The  above  entitled  memorandum  has  not  been  summarized  since 
it  is  in  itself  a  summary  of  certain  conditions.  To  fully  understand  and 
interpret  the  recommendations  set  forth  therein  it  will  be  necessary  to 
read  the  entire  memorandum. 


97 


Section    II.— CITIZENSHIP,    RESIDENCE,    AND    DEPEN- 
DENCE OF   PUBLIC   CHARGES 

1.  Aliens,     Non-Residents,     and     State     Poor     in     City 

Institutions 

2.  Admissions    to    City    Homes    (Almshouses) 


I.   ALIENS,   NON-RESIDENTS, 'AND   STATE   POOR 
IN   CITY   INSTITUTIONS 


STUDY    AND    INVESTIGATION 

BY 
H.    B.    DiNWIDDIE 

FOREWORD 

A,  Transition  in  the  Municipal  Problem  of  Alien  Dependence 
(I)  The  Problem  Originally  a  Municipal  Matter 

As  early  as  1769,  before  immigration  began  to  be  a  matter  of  public 
record,  provision  was  made  for  the  maintenance  of  dependent  immigrants 
in  the  form  of  a  "pesthouse,"  estabHshed  in  New  York  City  especially 
for  them. 

The  tide  of  immigration  to  the  United  States,  which  arose  about  a 
century  ago,  found  its  inception  in  economic  conditions  upon  the  European 
Continent.  Prior  to  that  time  immigration  had  not  been  so  steady,  but 
the  famines  prevailing  on  the  Continent  in  1816  and  1817  drove  a  large  num- 
ber of  poverty-stricken  immigrants  to  this  country,  of  whom  some  were  so 
destitute  that  they  sold  themselves  into  temporary  servitude  to  pay  their 
passage. 

Early  expression  was  given  to  the  belief  that  aliens  entailed  a  burden 
upon  the  community.  The  great  mortality  among  the  poor  during  the 
summer  of  1816  was  attributed  by  the  City  Inspector  of  the  City  and 
County  of  New  York  to  the  influx  of  immigrants  of  the  poorer  class,  who 
had  succumbed  because  of  their  physical  condition  and  the  fact  that  they 
had  not  become  acclimated. 

Much  more  vigorous  presentation  of  the  idea  was  made  by  interested 
citizens  who  were  not  public  officials.  The  Managers  of  the  Society  for 
the  Prevention  of  Pauperism,  of  the  City  of  New  York,  in  their  Second 
Annual  Report,  in  the  year  1819,  spoke  of  the  conditions  arising  from  the 
presence  of  immigrants  "in  the  language  of  astonishment  and  apprehen- 
sion" as  follows: 

Through  this  inlet  pauperism  threatens  us  with  the  most  overwhelming  conse- 
quences. The  present  state  of  Europe  contributes  in  a  thousand  ways  to  foster 
increasing  immigration  to  the  United  States.     .     .    . 

.  .  .  .  This  country  is  the  resort  of  vast  numbers  of  these  needy  and 
wretched  beings.  .  .  .  They  are  frequently  found  destitute  in  our  streets ;  they 
seek  employment  at  our  doors ;  they  are  found  in  our  almshouses  and  in  our 
hospitals.    .     .    . 

Recognition  of  the  heavy  contribution  of  aliens  to  the  almshouses  was 
shown  at  an  early  period.  In  January  of  1823  the  Superintendent  of 
the  Almshouse  of  the  City  of  New  York  sent  the  following  communica- 
tion to  the  Secretary  of  State: 

I  send  you  a  weekly  return  of  our  Almshouse,  ending  on  the  sth  inst,  by  which 
you  will  perceive  we  have  1,852  paupers,  1,017  of  whom  are  natives  (this  last  num- 
ber includes  all  the  children  of  foreign  parents)    and  835   foreigners. 

Originally  the  supervision  and  care  of  immigrants  in  the  United  States 
were  left  entirely  to  the  local  authorities  of  the  ports  at  which  they  were 
landed,  the  oversight  of  the  Federal  Government  affecting  them  onty  in 
their  ocean  transit.     Expenses  of  the  landing  and  care  of  the  immigrants 

103 


104  HOSPITAL   COMMITTEE 

were  met  at  first  by  the  local  authorities  of  New  York  City,  from  moneys 
levied  for  this  purpose  and  collected  in  connection  with  the  Poor  Fund. 

The  pressure  from  those  bearing,  or  interested  in,  the  municipal  bur- 
den of  alien  dependence  resulted  in  legislative  enactments.  In  the  early 
history  of  legislation  affecting  immigration  several  important  enactments 
were  made  by  the  Legislature  of  the  State  of  New  York.  On  February 
II,  1824,  the  State  Legislature  passed  an  act  "Concerning  Passengers  in 
Vessels  Coming  to  the  Port  of  New  York."  This  act  required  every  mas- 
ter and  commander  of  every  vessel  arriving  at  the  Port  of  New  York 
from  any  country  out  of  the  United  .States,  or  from  another  State,  to 
make  a  report  in  writing,  on  oath  or  affirmation,  to  the  Mayor  of  the  City 
of  New  York,  or  to  the  Recorder  of  the  City,  of  the  name,  place  of  birth, 
last  legal  settlement,  age,  and  occupation  of  every  person  brought  as  a 
passenger  in  the  ship.    The  same  act  authorized  the  Mayor 

To  require  .  .  .  every  such  master  or  commander  of  any  ship  or  vessel  to 
be  bound  with  two  sufficient  sureties  (to  be  approved  of  by  the  said  Mayor  or 
Recorder)  to  the  Mayor,  Aldermen,  and  Commonalty  of  the  City  of  New  York, 
in  such  sum  as  the  Mayor  or  Recorder  might  think  proper,  not  exceeding  three 
hundred  dollars  for  each  passenger  not  being  a  citizen  of  the  United  States,  to 
indemnify  and  keep  harmless  the  said  Mayor,  Aldermen,  and  Commonalty  and  the 
Overseers  of  the  Poor  of  the  said  City  and  their  successors,  from  all  and  every 
expense  or  charge  which  shall  or  may  be  incurred  by  them,  for  the  maintenance  and 
support  of  every  such  person  and  for  the  maintenance  and  support  of  the  child  and 
children  of  any  such  person  which  may  be  born  after  such  importation,  in  case 
such  person  or  any  such  child  or  children  shall  at  any  time  within  two  years  from 
the  date  of  such  bond  become  chargeable  to  the  said  City. 

This  act  was  inadequate,  for  reasons  that  cannot  be  definitely  given. 
Within  fifteen  years  after  its  passage  abnormal  pressure  upon  the  hospitals 
from  alien  patients  was  stated  to  exist,  even  at  that  very  early  stage,  and 
it  was  also  claimed  that  the  conditions  in  the  Almshouse  had  become  worse. 
In  a  Memorial  to  the  Mayor  and  Board  of  Aldermen  of  the  City  of  New 
York  by  the  General  Committee  of  Native  Americans,  presented  in  June, 
1837,  the  following  statements  were  made : 

On  the  1st  of  January,  1837,  982  foreigners  and  227  native  American  citizens 
had  been  admitted  to  the  Hospital  at  Bellevue  (in  one  year),  The  preceding 
year,  on  the  ist  of  May  last,  there  were  in  the  Almshouse  1,437  paupers.  Allowing 
the  same  proportion  as  in  the  Hospital,  there  will  be  1,068  foreigners  and  369 
native  American  citizens  in  the  Almshouse. 

It  appears  from  the  report  of  a  Commission  monthly  appointed  by  the  Board 
of  Aldermen  of  this  City  that  there  are,  at  the  date  of  this  report,  3,070  paupers  in 
the  Almshouse,  more  than  three-fourths  of  wkom  are  foreigners.  How  many 
more  of  this  class  live  upon  private  charities? 

Prior  to  this  time,  beginning  in  the  year  1824,  when  an  act  was  passed 
by  which  it  was  attempted  to  place  the  burden  of  dependence  of  immi- 
grants upon  the  steamship  authorities,  a  tax,  under  State  authority,  was 
levied  upon  the  passengers  arriving  at  the  Port  of  New  York  for  the  sup- 
port of  the  Marine  Hospital  at  Quarantine.  This  hospital  provided  for 
passengers  suffering  from  contagious  diseases  only. 

With  the  rapidly  increasing  immigration  during  the  time  from  1840  to 
1847  the  enforcement  of  this  act  was  found  to  be  very  inconvenient  to 
ship  owners,  and  entirely  inadequate  for  furnishing  necessary  aid  and 
relief  to  the  immigrants  who  became  sick  or  destitute.  The  establishment 
of  small  private  hospitals — from  motives  of  economy — resulted,  so  that 
sick  and  infirm  aliens  might  be  cared  for  in  them,  instead  of  public  insti- 
tutions, at  the  expense  of  the  shipping  authorities.    As  the  bonds  required 


ALIENS  AND   NON-RESIDENTS 


105 


in  this  act  remained  uncancelled  for  a  long  time,  they  became  onerous,  es- 
pecially to  the  better  class  of  ship  owners,  while  sometimes,  in  the  case 
of  others,  it  was  found  impracticable  to  enforce  the  agreement. 

(n)  The  Attempt  to  Assign  the  Problem  to  the  State 

The  cause  of  dependence  was  long  ago  traced  to  the  deficiency  in  the 
physical  and  financial  condition  of  aliens  at  landing.  In  his  report  for 
1846  the  Comptroller,  John  Ewen,  of  the  City  of  New  York,  called  atten- 
tion to  "foreign  paupers  who,  in  some  instances,  within  a  day  or  two  after 
landing,  were  taken  from  the  wharves  in  large  numbers  in  a  state  of  desti- 
tution and  sent  to  the  Almshouse."  The  number  of  diseased  immigrants 
increased  out  of  proportion  to  the  increase  in  immigration,  and  was  con- 
sidered a  menace  to  public  health. 

The  most  serious  objection  raised  to  the  act  of  1824  had  been  that  this 
effort  had  not  resulted  in  sufficient  provision  for  the  care  and  relief  of  the 
needy  immigrant.  No  relief  had  been  afforded  for  those  needing  it  from 
causes  other  than  disease. 

Consequently,  in  the  year  1847  an  act  designed  to  meet  the  needs  was 
passed  by  the  Legislature  of  this  State.  This  law  provided  a  permanent 
commission  for  the  relief  and  protection  of  alien  immigrants  "arriving  at 
the  Port  of  New  York.  These  immigrants,  by  this  law,  were  entitled  to 
aid  for  five  years  after  their  arrival,  from  a  fund  created  by  a  small  com- 
mutation payment  for  each  immigrant.  All  the  property  at  Quarantine 
Hospital,  and  the  government  thereof,  were  transferred  to  this  Commis- 
sion of  Emigration,  and  other  institutions  for  immigrants  subsequently 
built  were  placed  under  its  control. 

This  State  Commission  of  Emigration  erected  a  hospital  on  Ward's 
Island;  also  a  nursery  building  for  children,  containing  dormitories  and 
facilities  for  the  education  and  recreation  of  the  children  of  the  immi- 
grants. The  immigrants  who  had  been  landed  in  an  insane  condition 
from  the  ships,  or  had  been  found  so  afflicted  in  this  vicinity,  were  accom- 
modated in  an  asylum  on  Blackwell's  Island.  Cases  of  accident  or  emer- 
gent illness  were  cared  for  at  the  New  York  Hospital,  by  an  arrange- 
ment made  with  that  institution,  such  patients  being  transferred  to  the 
Ward's  Island  Hospital  or  the  Marine  Hospital,  as  soon  as  possible. 

The  Commissioners  of  Emigration,  created  by  this  act,  were  responsi- 
ble for  reimbursing  the  City  for  the  expenses  of  the  different  classes  of 
aliens  described,  from  a  fund  raised  by  requiring  a  small  payment  for 
each  immigrant.  Within  a  very  few  years  the  City  found  considerable  diffi- 
culty in  securing  this  reimbursem.ent.  Bills  were  long  outstanding,  and 
the  debt  claimed  by  the  board  of  Governors  of  the  Almshouse  for  the 
support  and  maintenance  of  aliens  in  the  Almshouse,  Lunatic  Asylum, 
and  Hospital,^  on  behalf  of  the  City,  became  the  subject  of  bitter  contro- 
versy. 

Over  half  a  century  ago  a  complaint  arose  on  the  part  of  the  charitable 
agents  of  the  City  that  the  State  authorities  whose  function  it  was  to 
relieve  the  communities  of  the  burden  of  alien  dependents  were  not  ful- 
filling their  task,  and  were  arbitrarily  deciding  that  the  burden  of  many 
aliens  should  not  be  taken  off  the  City  by  them.     In  the  Seventh  Annual 

'  The  records  are  not  clear  as  to  the  official  titles  of  the  City's  early  institutions, 
but  inasmuch  as  the  reference  to  Governors  of  the  Almshouse  requires  the  capitaliza- 
tion of  the  name  of  that  institution,  the  same  form  has  been  followed  in  the  designa- 
tion of  the  others. — Editor. 


io6  HOSPITAL   COMMITTEE 

Report  of  the  Board  of  Governors  of  the  Almshouse,  for  the  year  1855, 
they  registered  the  following  complaint: 

The  Board  need  not  remind  you  that  they  refer  to  the  unjust  imposition  upon 
the  citizens  of  New  York  by  the  large  number  of  vagrants,  prisoners,  and  lunatics, 
as  well  as  outdoor  poor,  who  are  thrown  upon  them  through  the  inability  of  the 
Commissioners  of  Emigration  to  support  those  who  are  thrown  upon  public  charity 
during  the  first  five  years  of  their  residence  here.  The  sum  already  expended  has 
reached  $60,000,  without  including  all  previous  time  when  no  account  was  rendered. 
This  evil  still  exists,  and,  unless  some  action  is  had  to  remedy  it,  the  burden  will 
reach  beyond  the  present  claims  made  for  their  support. 

The  rejoinder  of  the  Commissioners  of  Emigration  was  that  many  of 
the  immigrants  who  were  a  burden  upon  the  City  had  been  committed  to 
the  institutions  under  the  charge  of  the  Governors  of  the  Almshouse  for 
vagrancy,  for  which  reason  they  did  not  feel  called  upon  to  pay  for  their 
maintenance. 

By  act  of  the  Legislature  in  1855  certain  classes  of  these  immigrants 
who  had  been  confined  after  conviction  as  vagrants  and  disorderly  persons 
were  specified  as  being  proper  charges  for  maintenance  by  the  Emigration 
Commission.  However,  in  the  year  1856,  the  Board  of  Governors,  in  their 
Eighth  Annual  Report,  stated,  in  regard  to  the  burden  upon  them,  that : 

During  the  last  year  nothing  has  been  received  from  the  Commissioners  of 
Emigration  except  a  trifling  amount  for  actual  services  and  disbursements  for  the 
burying  of  the  dead. 

And  in  the  report  of  the  Governors  of  the  Almshouse  in  1857  the  fol- 
lowing testimony  was  given  : 

That  out  of  597  patients  remaining  in  the  Lunatic  Asylum  on  January  18,  1857, 
77  were  recent  immigrants  entitled  to  support  from  the  Commissioners  of  Emigra- 
tion, the  law  requiring  such  shall  thus  be  maintained  until  the  expiration  of  five 
years  after  landing  in  New  York. 

Ill  admitted  as  recent  immigrants  by  reason  of  the  expiration  of  the  time 
during  which  they  would  be  chargeable  to  the  Commissioners,  remain  a  charge 
upon  the  City.  No  residence  has  been  obtained  so  as  legally  to  entitle  them  to 
support.  Some  who  had  never  resided  in  this  City  were  sent  from  other  counties 
of  the  State  when  the  five  years  had  nearly  expired. 

25  had  been  admitted  within  a  year  after  their  support  by  the  Commissioners 
had  ceased,  of  whom  many  were  inmates  of  Ward's  Island,  and  a  few  transferred 
directly  from  that  place.     ... 

71  per  cent,  of  the  inmates  of  Blackwell's  Island  Hospital  were  foreigners;  72 
per  cent,  of  the  inmates  of  the  Penitentiary;  75  per  cent,  of  the  Workhouse;  and 
75  per  cent,  of  the  Almshouse  were  foreigners. 

In  spite  of  the  deficiency,  as  claimed,  in  the  relief  afforded  by  the  State 
Emigration  Commission  this  relief  was  of  a  very  substantial  nature  for  those 
days,  and  large  expenditures  of  money  that  would  otherwise  have  fallen 
upon  the  community  were  defrayed  by  the  "immigration  fund"  of  the  State 
Commissioners  of  Emigration.  These  Commissioners  of  Emigration  re- 
ported that  the  aggregate  sum  they  had  expended  in  New  York  City,  which 
represented  the  extent  to  which  tlie  City  had  been  relieved  from  the  burden 
of  caring  for  the  immigrant  dependents  from  the  year  1847.  when  the  Com- 
mission was  organized,  to  the  year  1855,  had  amounted  to  $2,250,000. 

Commissioner  of  Emigration  Friedrich  Kapp,  in  a  paper  read  before  the 
American  Social  Science  Association  at  New  York  on  October  27,  1869, 
stated  that  the  cost  of  maintaining  11,313  inmates  of  the  hospitals  and  asy- 
lums on  Ward's  Island  was  $230,000  (for  the  preceding  year),  in  addition 


ALIENS  AND   NON-RESIDENTS  107 

to  which  a  little  over  $100,000  was  paid  to  the  hospitals,  and  cities  and  coun- 
ties of  the  State,  for  the  nursing  and  support  of  immigrants. 

In  their  argument  against  the  question  of  Federal  supervision  of  immi- 
gration, which  had  then  arisen,  the  Commissioners  of  Emigration  in  1873 
submitted  a  review  to  the  Senate  of  the  United  States  of  their  work,  of 
which  the  following  is  an  extract : 

1  Number  of  alien  immigrants  arrived  at  the  Port  of  New  York  from  May  5, 

1847,  to  December  31,  1872,  for  whom  commutation  money  was  paid 5,033,392 

Of  which  number  the  Commissioners  of  Emigration  provided  and  cared 
for  out  of  the  emigrant  fund  for  a  greater  or  less  period  during  the  five 

years  subsequent  to  arrival 1,465,579 

as  follows: 

Number  treated  and  cared  for  in  the  institutions  of  the 

Commissioners  of  Emigration 398,643 

Number  supplied  temporarily  with  board,   lodging,   and 

money  relief  in  the  City  of  New  York 449,275 

Number  provided  with  employment  through  the  Labor 

Bureau  at  Castle  Garden 349,936 

Number  forwarded  from  Castle  Garden  to  destination  in 

United  States  at  their  own  request 53,083 

Number  relieved  and  provided  for  in  various  counties  and 
institutions  at  the  expense  of  Commissioners  of  Emigra- 
tion    214,642 

2  That  the  advantages  of  all  this  costly  and  elaborate  provision,  gradually  perfected 
through  many  years,  ought  not  to  be  lightly  cast  aside. 

3  That  without  radical  changes  in  the  law  of  the  land,  it  would  be  impossible  for  a 
Federal  Bureau  to  extend  to  the  arriving  immigrant  the  same  amount  and  kind  of 
protection  that  the  organization  of  the  New  York  State  Commission  enables  it  to 
render. 

The  Federal  law  does  not  recognize  paupers  who  are  subjects  only  of  local  law, 
and  the  effect  of  abolishing  the  State  Commission  would  apparently  be  to  throw  the 
impoverished  or  invalid  immigrant  on  local  charity  for  maintenance.  This  would 
be  to  inflict  a  heavy,  unnecessary,  and  very  unequal  burden  on  the  people,  to  excite 
local  prejudice  against  immigration,  and,  by  making  the  immigrant  the  recipient  of 
alms,  to  hurt  him  fatally  in  all  the  qualities  that  constitute  a  useful  citizen.  The  help 
the  State  Commission  gives  him  he  may  take  without  humiliation  or  loss  of  self- 
respect,  since  it  is  paid  for  by  himself,  and  dispensed  by  his  own  trustees.  A 
Federal  Bureau  must  leave  him  in  sickness  and  poverty  to  the  degrading  succor  of  the 
poorhouse. 

(in)  Federal  Action  upon  State  Handling  of  the  Problem 

In  January,  1875,  the  validity  of  the  New  York  State  law  requiring  a 
bond  from  the  shipping  authorities,  and  permitting  commutation  payments 
thereon  to  be  made  by  the  immigrant  passengers,  was  brought  before  the 
Supreme  Court  of  the  United  States.  In  March,  1876,  the  Supreme  Court 
declared  this  law  unconstitutional  and  void,  and  thus  terminated  contribu- 
tions to  the  fund  out  of  which  the  Commissioners  of  Emigration  furnished 
support  to  the  immigrants.  Because  State  officials  had  issued  receipts  for  the 
commutation  money  previously  paid  by  immigrants  with  the  agreement 
that  these  immigrants  should  receive  the  support  that  should  be  needed 
during  the  five  years  after  their  arrival,  the  Legislature  of  New  York  State, 
in  1876,  appropriated  sufficient  funds  to  execute  the  pledges  already  made 
to  immigrants  who  had  arrived  at  the  Port  of  New  York  prior  to  this 
time;  but  no  provision  was  made  for  those  who  arrived  subsequently. 
The  burden  of  their  maintenance,  therefore,  fell  upon  the  municipal 
authorities. 


I08  HOSPITAL   COMMITTEE 

Repeated  efforts  were  made  for  several  years  following  to  secure  legis- 
lation from  Congress  that  should  furnish  adequate  control  over  immigra- 
tion and  protection  for  both  the  immigrant  and  the  communities  of  this 
and  other  states.  These  efforts  having  failed,  the  pressure  upon  the  insti- 
tutions of  this  locality  for  the  support  and  care  of  insane  and  other  alien  de- 
pendents resulted  in  an  act  of  the  Legislature  in  1880,  by  which  the  New 
York  State  Board  of  Charities  was  authorized  to  cause  to  be  removed  to 
the  countries  from  which  they  came,  the  crippled,  blind,  lunatic,  or  other 
infirm  alien  paupers  sent  to  this  country,  found  in  any  poorhouse,  alms- 
house, or  any  institution  of  charity  in  the  State. 

In  the  year  1881  the  Commissioners  of  Emigration  requested  an  appro- 
priation of  $200,000  from  the  State  Legislature  to  carry  on  the  work  of  the 
Commission  during  the  fiscal  year  ending  May  i,  1882.  Only  $150,000  was 
appropriated,  however,  which  resulted  in  another  appeal  to  the  Legislature 
and  an  additional  appropriation  of  $40,000  for  this  fiscal  year. 

To  avoid  a  recurrence  of  this  great  burden  upon  the  State  an  act  of  the 
Legislature  was  passed  in  June,  1882,  granting  to  the  Commissioners  of 
Emigration  power  to  exclude  from  the  benefits  of  the  State  Emigrant  insti- 
tutions at  Castle  Garden  and  Ward's  Island  passengers  of  such  steamship) 
companies  as  refused  to  pay  to  the  Commissioners  a  sum  amounting  to  not 
less  than  fifty  cents  for  each  alien  passenger  landed  by  them  at  Castle  Gar- 
den. After  some  demur  the  steamship  companies  paid  this  tax  until  the 
passage  of  a  Federal  law  less  than  three  months  later. 

(IV)  Federal  Assumption  of  the  Alien  Problem 

On  August  3,  1882,  the  President  approved  an  act  of  Congress  for  a 
Federal  tax  on  ship  owners  of  fifty  cents  for  each  alien  passenger  landed 
in  ports  of  the  United  States.    This  act  provided  that : 

The  Secretary  of  the  Treasury  is  hereby  charged  with  the  duty  of  executing 
the  provisions  of  this  act,  and  with  supervision  over  the  business  of  immigration 
to  the  United  States,  and,  for  that  purpose,  he  shall  have  power  to  enter  into 
contracts  with  such  state  commission,  board  or  ofBcers  as  may  be  designated  for 
that  purpose  by  the  governor  of  the  state,  to  take  charge  of  the  local  affairs  of 
immigration  in  the  ports  within  said  state,  and  to  provide  for  the  support  and  relief 
of  such  immigrants  therein  landing  as  may  fall  into  distress  or  need  public  aid, 
under  the  rules  and  regulations  to  be  prescribed  by  said  Secretary. 

This  act  also  prescribed  that: 

It  shall  be  the  duty  of  such  state  commission,  board  or  officers  so  designated, 
to  examine  into  the  condition  of  passengers  arriving  at  the  ports  within  such 
state  in  any  ship  or  vessel,  and,  for  that  purpose,  all  or  any  of  sudi  commis- 
sioners or  officers,  or  such  other  person  or  persons  as  they  shall  appoint,  shall  be 
authorized  to  go  on  board  of  and  through  any  such  ship  or  vessel;  and  if,  on 
such  examination,  there  shall  be  found  among  such  passengers  any  convict,  lunatic, 
idiot,  or  any  person  unable  to  take  care  of  himself  or  herself,  without  becoming 
a  public  charge,  they  shall  report  the  same  in  writing  to  the  collector  of  such  port, 
and  such  persons  shall  not  be  permitted  to  land. 

The  function  of  the  State  Commission,  heretofore  fulfilled  merely  as 
one  of  local  interest,  was  hereby  temporarily  recognized  by  Federal  legis- 
lation. 

This  act  of  Congress  provided  for  relieving  New  York  City,  as  well  as 
other  communities,  from  the  burden  of  all  aliens  who  became  public  charges 
within  one  year  after  arrival  from  causes  existing  prior  to  landing,  by  de- 
portation and  by  reimbursement  to  the  City  at  the  expense  of  the  steamship 


ALIENS  AND   NON-RESIDENTS  109 

companies.  Also,  the  immigrants  lawfully  landed  who  became  public 
charges  within  one  year  after  date  of  landing  and  seemed  likely  to  become 
chronic  dependents  could  be  removed  at  the  expense  of  the  "immigration 
fund,"  and  the  expense  of  their  maintenance,  up  to  the  expiration  of  the 
year  subsequent  to  their  landing,  could  be  paid  out  of  that  fund,  to  be  col- 
lected by  the  United  States  Government  by  a  head  tax  on  immigrants. 

(V)  Inferiority  of  Federal  Relief  to  that  of  the  State 

The  provision  previously  afforded  for  the  maintenance  of  all  immi- 
grants, except  criminals,  out  of  the  fund  of  the  State  Commissioners  of 
Emigration  was  taken  away  from  the  City  when  Federal  authorities  re- 
placed those  of  the  State,  and  the  only  payment  offered  by  the  Federal  Gov- 
ernment for  the  maintenance  of  aliens  in  an  institution  of  this  City  termi- 
nated at  the  expiration  of  one  year  after  the  time  of  landing.  Further- 
more, there  had  been  no  limit  placed  upon  the  power  of  the  State  authori- 
ties as  to  the  duration  of  the  time  after  landing  within  which  they  might 
deport  immigrants,  but  by  the  act  of  1882  this  was  limited  to  one 
year  for  the  Federal  authorities,  and  although  by  the  act  of  1891  this  time 
was  extended,  it  was,  and  still  is,  limited  to  three  years.  Also,  the  time 
after  landing  within  which  the  Federal  Government  could  reimburse  the 
City  was  reduced  to  three  years  from  the  five-year  period  for  which  the 
State  had  borne  the  maintenance.  Furthermore  the  State  law  provided  for 
the  maintenance  of  all  aliens  that  became  dependent  in  the  five  years,  but 
the  Federal  provision  was  only  for  very  limited  classes. 

(VI)  The  Lapsing  of  the  Federal  Contract  to  Relieve  the  State 

The  contract  into  which  the  Secretary  of  the  Treasury  and  the  Com- 
missioners of  Emigration  of  the  State  of  New  York  entered  under  the  act 
of  1882  was  discontinued  March  3,  1891,  when,  by  an  act  of  Congress,  the 
office  of  Superintendent  of  Immigration  was  created  and  established,  al- 
though a  similar  contract  continued  for  twenty  years  longer  between  the 
immigration  authorities  and  the  State  authorities  in  Massachusetts.  A 
United  States  Commissioner  of  Immigration  was  placed  in  charge  of  the 
Port  of  New  York,  and  supplanted  the  State  Commissioners  of  Emigra- 
tion in  their  function  by  taking  control  of  the  landing,  supervision,  and 
care  of  immigrants  at  this  port.  At  this  time,  when  this  entire  control 
passed  into  the  hands  of  Federal  officials,  the  offices  were  removed  from 
Castle  Garden  to  the  new  buildings  on  Ellis  Island. 

(VII)  Increasing  Severity  in  Federal  Provision  for  Exclusion 

Although  the  sense  of  responsibility  of  the  Federal  authorities  for  the 
relief  of  the  local  authorities  from  the  burden  of  dependent  aliens  seemed 
to  become  less  definite.  Federal  legislation,  as  it  progressed,  exhibited  in- 
creasing appreciation  of  the  need  of  exclusion.  The  act  of  1882  specified 
that,  if  there  should  be  found  among  the  alien  passengers  on  ships  "any 
convict,  lunatic,  idiot,  or  any  person  unable  to  take  care  of  himself  or  her- 
self without  becoming  a  public  charge  .  .  .  such  persons  shall  not  be 
permitted  to  land,"  but  by  the  act  of  1891  (and  preceding  legislation)  the 
list  of  excluded  persons  was  enlarged  to  cover  the  following: 

.  .  .  Idiots,  insane  persons,  paupers,  or  persons  likely  to  become  a  public 
charge,  persons  suffering  from  loathsome  or  dangerous  contagious  diseases,  per- 
sons who  might  have  been  convicted  of  a  felony  or  other  infamous  crime,  or  mis- 


no  HOSPITAL   COMMITTEE 

demeanor  involving  moral  turpitude,  polygamists  and  also  any  person  whose  ticket 
or  passage  had  been  paid  for  with  money  of  another  or  who  was  assisted  by  others 
to  come,  unless  satisfactorily  shown,  on  special  inquiry,  that  such  person  did  not 
belong  to  any  of  the  excluded  classes,  or  to  the  class  of  contract  laborers  excluded 
by  the  act  of   1885. 

By  the  time  the  act  of  1907  was  passed  there  had  been  added  to  this 
list  of  excluded  persons: 

imbeciles,  feeble-minded  persons,  epileptics.  .  .  .  persons  who  have  been  insane 
within  five  years  previous;  persons  who  have  had  two  or  more  attacks  of  insanity 
at_  any  time  previously;  paupers;  .  .  .  professional  beggars;  persons  afflicted 
with  tuberculosis ;  .  .  .  persons  not  comprehended  within  any  of  the  foregoing 
excluded  classes  who  are  found  to  be  and  are  certified  by  the  examining  surgeon 
as  being  mentally  or  physically  defective,  such  mental  or  physical  defect  being  of 
a  nature  which  may  affect  the  ability  of  such  alien  to  earn  a  living. 

The  list  also  included  classes  more  directly  affecting  social  problems  other 
than  those  of  dependence. 

In  a  bill  introduced  in  the  63d  Congress,  in  1913,  as  Senate  Bill  50  and 
House  of  Representatives  Bill  1,958,  a  further  attempt  to  protect  the  coun- 
try from  the  burden  of  dependent  aliens  seems  evidenced  by  the  addition  to 
the  excludable  classes  of  the  following: 

male  persons  over  sixteen  years  of  age  who  do  not  possess  in  their  own  right  $50 
in  lawful  money  of  the  United  States  or  other  money  of  equivalent  value;  .  .  . 
vagrants ;  male  persons  between  the  ages  of  sixteen  and  fifty  coming  to  perform 
skilled  or  unskilled  manual  labor  who  are  found  to  be  and  are  certified  by  an 
examining  surgeon,  who  shall  call  in  two  other  examining  surgeons  to  concur  in 
such  certification,  as  below  the  physical  standard  now  observed  for  recruits  for  the 
United  States  naval  service. 

By  this  bill  it  was  proposed  to  extend  the  period  of  time  for  deportation  of 
aliens  and  for  reimbursement  of  their  expenses  to  five  years  after  landing. 

(Vin)  Small  Amount  of  Federal  Relief  Afforded  to  the  City  at  Present 

Substantial  numbers  of  alien  dependents  were  transferred  from  New 
York  City  by  the  Department  of  Public  Charities  to  the  Commissioners  of 
Immigration  twenty  years  ago,  and  the  removal  of  aliens  by  the  State 
Board  of  Charities  was  then  of  insignificant  proportions.  This  transfer- 
ence from  the  Department  of  Public  Charities  to  the  Commissioners  of 
Immigration  ceased  with  the  year  1905.  By  the  order  of  the  Commissioner  of 
Charities  who  came  into  office  in  January,  1906,  all  aliens  found  in  the 
institutions  of  the  Department  were  required  to  be  referred  to  the  De- 
partment of  State  and  Alien  Poor  of  the  State  Board  of  Charities.  From 
that  time  to  the  present  the  relief  afforded  New  York  City  institutions  by 
the  removal  of  aliens  has  been  through  State  rather  than  through  Fed- 
eral agents. 

According  to  the  monthly  reports  of  the  Department  of  State  and  Alien 
Poor  of  the  State  Board  of  Charities  for  the  fiscal  year  ended  September 
30,  1912,  the  United  States  Immigration  Service  removed  only  7  aliens 
from  the  Department  of  Bellevue  and  Allied  Hospitals  (and  the  State  Board 
of  Charities  only  103).  According  to  the  examination  made  by  this  Com- 
mittee in  1913  there  would  be  admitted  to  Bellevue  Hospital  alone  in  a 
year  5,600  alien  patients  deportable  under  the  existing  Federal  and  State 
laws. 

As  early  as  1869  the  State  Commission  of  Emigration  saved  the  City 
$230,000  in  a  year  by  maintaining  immigrants   (and  the  sum  of  $100,000 


ALIENS  AND   NON-RESIDENTS  III 

was  paid  to  institutions  throughout  the  State  not  under  their  control).  The 
annual  expense  of  maintaining  aliens  in  the  hospitals  and  almshouses  of 
the  Departments  of  Bellevue  and  Allied  Hospitals  and  of  Public  Charities, 
on  the  basis  of  the  examination  made  in  1912  and  1913,  is  estimated  to  be 
over  $900,000.  The  average  payments  to  the  City  from  the  State  Board 
of  Charities  (as  agents  of  the  Federal  Government)  in  191 1  was  less  than 
$10,000,  and  in  1910  less  than  $6,000.  Prior  to  that  time  no  payments  appear 
to  have  been  made. 

The  fund  formerly  collected  by  the  State  from  immigrants  is  now  col- 
lected by  the  Federal  Government.  This  fund,  raised  by  head  tax,  is  now 
turned  into  the  United  States  Treasury,  and  the  expenses  of  the  immigra- 
tion service  are  defrayed  by  appropriations  from  the  Government's  general 
funds,  and  not,  as  heretofore,  by  direct  expenditure  of  the  head  tax.  There 
is  a  surplus  of  over  $1,000,000  annually  being  turned  into  the  United  States 
Treasury  over  and  above  the  amount  drawn  from  that  source  to  defray  the 
expenses  of  the  immigration  service.  Thus,  a  large  portion  of  the  head  tax 
fund,  originally  started  by  the  State,  has  been  diverted  from  its  original 
purpose  and  become  a  source  of  revenue.  Meanwhile,  this  municipality, 
which  bears  most  heavily  the  burden  of  dependence  of  aliens,  has  to  sup- 
ply the  deficiency  in  the  Federal  relief  out  of  its  own  treasury. 

The  Government  for  some  years  has  not  spent  an  average  of  $150,000 
annually  for  its  entire  medical  service  for  immigrants,  inclusive  of  hospital 
facilities.  Were  the  $1,000,000  surplus  of  this  head  tax  fund  devoted  to 
the  exclusion  of  those  likely  to  become,  and  the  removal  of  those  who  have 
become,  dependents,  great  relief  would  be  afforded  to  the  City  of  New  York. 

The  following  is  a  copy  of  a  letter  recently  sent  to  an  official  in  New 
York  City  (a  similar  letter  was  sent  to  other  public  officials  connected  with 
the  oversight  of  public  charges)  : 


United  States  Department  of  Labor. 

December  24,  1913. 

Sir:  I  have  to  inform  you  that  the  Secretary  of  Labor  has  suspended  that 
portionof  subdivision  7,  Rule  22,  of  the  Immigration  Regulations  which  relates  to 
the  maintenance  of  aliens  who  become  public  charges  from  causes  existing  prior 
to  landing,  such  suspension  to  become  effective  December  31,  1913,  after  which 
date  maintenance  bills  for  the  care  of  alien  public  charges  will  not  be  paid  by  the 
Government. 

The  necessity  for  this  suspension  lies  in  the  fact  that  Congress  has  not  suffi- 
ciently provided  for  the  maintenance  and  upkeep  of  the  Immigration  Service  dur- 
ing the  current  fiscal  year  and  vigorous  retrenchment  is  necessary.  There  is  no 
requirement  of  law  which  obligates  the  Government  to  pay  these  bills,  and  the  only 
remedy  for  the  situation  lies  in  an  increased  appropriation  by  Congress. 

Respectfully 

Byron  W.  Uhl 

Acting  Commissioner 

This  recent  order  carries  still  further  the  tendency  of  the  Federal  Gov- 
ernment to  throw  upon  the  locality  the  burden  of  caring  for  aliens,  whether 
or  not  such  aliens  have  been  improperly  admitted  by  Federal  officers. 


112  HOSPITAL   COMMITTEE 

B.  Some  Points  of  Contrast  between  the  Handling  of  Alien,  Non-Resident, 
and  State  Poor  Dependents  in  the  State  of  Massachusetts  and 
in  the  State  of  New  York 
(I)  Aliens 

(o)  Agreement  between  the  State  and  United  States  Authorities 

For  a  period  of  many  years  prior  to  June  30,  191 1,  there  was  in  exis- 
tence an  annually  renewed  contract  between  the  State  Board  of  Charity  of 
the  State  of  Massachusetts  and  the  Commissioner  of  Immigration  at  the 
Port  of  Boston,  by  which  the  Immigration  Service  agreed  to  reimburse,  at 
a  stipulated  rate,  the  State  Board  of  Charity  for  aliens  maintained  in  the 
hospitals  or  elsewhere  within  the  State  who  had  become  pubHc  charges  by 
reason  of  accident,  bodily  ailment,  disease,  or  physical  or  mental  inability 
to  earn  a  living. 

This  agreement  bound  the  Immigration  Service  to  reimburse  the  State 
Board  of  Charity  for  (i)  the  aliens  who  had  become  public  charges  from 
causes  arising  subsequent  to  landing  until  deportation  or  until  the  expira- 
tion of  one  year  after  the  alien's  entry  into  the  United  States,  and  (2)  for 
the  aliens  who  had  become  public  charges  from  causes  existing  prior  to 
arrival  in  this  country,  and  whose  deportation  was  ordered  by  the  Depart- 
ment of  Commerce  and  Labor  for  this  reason,  from  the  date  that  the  Secre- 
tary of  Commerce  and  Labor  issued  a  warrant  for  the  arrest  of  the  par- 
ticular alien  up  to  the  time  of  the  deportation.  Under  the  contracts  prior 
to  that  existing  for  the  year  1910-1911  the  United  States  Government  was 
liable  for  maintenance  charges  of  aliens  who  were  public  charges  from 
prior  causes  from  the  date  of  notification  by  the  State  authorities  that  the 
particular  alien  was  a  public  charge,  and  not  from  the  date  that  the  warrant 
for  this  alien's  arrest  for  deportation  was  issued. 

The  State  Board  of  Charity  agreed  to  transport  to  and  receive  into  the 
hospitals  and  institutions  under  its  control  the  above  classes  of  aliens,  and 
to  furnish  them  all  necessary  treatment  and  care,  or  to  supply  this  at  their 
residences  in  case  life  or  public  health  would  be  jeopardized  by  removal. 

In  the  City  of  New  York  aliens  are  maintained  at  a  heavy  expense 
without  any  agreement  between  the  United  States  officials  and  the  munici- 
pal or  State  authorities,  and  the  City  is  reimbursed  only  for  a  negligible 
proportion  of  its  expenditure  in  maintaining  these  aliens.  In  the  years  from 
1902  to  1905  the  Department  of  Public  Charities  referred  considerable 
numbers  of  aliens  directly  to  the  Commissioner  of  Immigration.  These 
aliens  were  maintained,  it  is  understood,  in  the  institutions  at  Ellis  Island 
at  the  expense  of  the  Federal  Government  and  the  City  was  thereby  re- 
lieved. After  the  year  1905  this  practice  was  discontinued,  and,  although 
there  are  large  numbers  of  aliens  being  supported  in  the  municipal  insti- 
tutions, no  such  relief  is  afforded  the  City  at  the  present  time. 

(&)  Removal  Agencies 
Under  the  law  of  the  State  of  Massachusetts  the  overseers  of  the  poor 
in  their  respective  places  are  required  to  report  immediately  to  the  State 
Board  of  Charity  every  recipient  of  public  relief  not  having  a  legal  settle- 
ment within  the  State,  and  the  State  Board  of  Charity  is  authorized  to  re- 
move such  persons  to  the  State  Hospital  or  to  any  place  to  which  they  may 
belong.  Also,  a  justice  of  the  superior  court,  or  of  a  police,  district,  or 
municipal  court,  or  a  trial  justice  may,  upon  an  application  by  tlie  overseers 


ALIENS  AND  NON-RESIDENTS 


"3 


of  the  poor  of  any  place,  or  by  the  State  Board  of  Charity,  by  a  warrant 
directed  to  a  constable  or  other  person  therein  designated,  cause  any  alien 
or  non-resident  pauper  who  is  not  a  proper  public  charge  within  the  State 
to  be  conveyed  to  the  country  where  he  belongs. 

In  the  City  of  New  York  relief  is  afforded  to  the  City  poor  authorities 
from  the  burden  of  alien  dependents  through  application  to  either  the 
State  Board  of  Charities  or  the  United  States  Immigration  Service.  There 
is  no  specific  power  for  enforced  removal  conferred  upon  any  local 
authority. 

(n)  Non-Residents 

(o)  Non-Residents  of  the  State 

In  the  State  of  Massachusetts  only  those  non-residents  of  the  State 
seem  to  be  permissible  as  charges  upon  the  local  authorities  whose  main- 
tenance is  considered  to  be  for  the  public  interest.  Poor  persons  without 
a  settlement  in  the  State  are  designated  as  State  Paupers  and  may  be 
sent  by  the  overseers  of  the  poor  to  the  State  hospital,  to  be  maintained 
at  the  public  charge.  Their  removal  from  the  State  may  be  effected  by  the 
State  Board  of  Charity. 

The  State  Board  of  Charities  of  the  State  of  New  York  is  authorized  to 
remove  non-residents  of  the  State  therefrom,  but  no  provision  is  made  for 
their  maintenance  at  the  expense  of  the  State,  except  in  the  case  of  such  as 
have  lived  less  than  sixty  days  in  any  county  of  the  State  within  one  year 
preceding  the  date  of  their  application  for  relief.  This  limited  class  is  re- 
ferred to  under  the  title  of  State  Poor. 

All  non-residents  of  the  State  maintained  in  the  New  York  municipal 
institutions  that  have  been  in  the  City  more  than  sixty  days  are  maintained 
entirely  at  the  municipal  expense. 

{b)  Non-Residents  of  Towns  and  Cities 

Dependents  who  have  a  lawful  settlement  at  other  places  within  the 
State  of  Massachusetts  must  be  afforded  immediate  relief  by  the  overseers 
of  the  poor  in  any  place  in  which  these  dependents  shall  fall  into  distress 
and  stand  in  need  of  relief,  until  their  removal  to  the  place  of  their  settle- 
ment. The  expense,  however,  of  their  maintenance,  of  their  removal,  or  of 
their  burial  in  case  of  their  decease,  may  be  recovered  by  an  action  against 
the  place  where  the  dependent  belongs. 

Provision  is  made  in  the  law  of  the  State  of  New  York  for  the  recov- 
ery of  the  expense  of  the  support  of  a  poor  person  who  shall  come  into  a 
county  or  town  not  legally  chargeable  with  his  support.  This  recovery  may 
be  made  by  the  overseers  of  the  poor  furnishing  this  support  from  the  poor 
authorities  of  the  place  where  the  poor  person  has  his  legal  settlement. 
Under  the  interpretation  of  the  Supreme  Court,  however,  this  provision  of 
the  law  has  been  held  not  to  authorize  such  recovery  when  a  person  has 
become  a  poor  person  after  he  has  left  the  town  or  county  in  which  he  had 
gained  a  settlement. 

Therefore,  there  falls  upon  the  overseers  of  the  poor  of  the  City  of 
New  York  the  burden  of  maintaining  as  public  charges  those  poor  persons 
without  lawful  settlement  in  the  City  who  were  not  public  charges  as  poor 
persons  in  the  place  of  their  legal  settlement,  although  this  settlement  may 
have  been  of  lifelong  duration. 


114  HOSPITAL  COMMITTEE 

(m)  state  Poor 

In  the  State  of  Massachusetts  all  poor  persons  who  have  no  legal  settle- 
ment within  the  State  are  State  Paupers,  for  whose  expense  the  State  is 
liable,  either  by  maintenance  in  State  institutions  or  by.  reimbursement  to 
local  authorities.  A  settlement  of  five  years  in  a  city  or  town  is  the  general 
requirement  to  entitle  a  poor  person  to  maintenance  by  the  city  or  town. 

A  State  Poor  person  in  the  State  of  New  York  is  a  dependent  who 
has  not  resided  in  any  county  within  the  State  for  sixty  days  within  one 
year  preceding  the  time  of  application  by  him  to  any  overseer  of  the  poor 
for  aid.  Under  the  law  these  persons  must  be  maintained  in  the  State 
Almshouses  only.  The  burden  of  the  maintenance  of  all  non-residents  of 
the  State  as  poor  persons  who  have  resided  in  this  City  for  sixty  days  and 
over  within  the  year  preceding  the  time  of  appHcation  for  relief  falls  upon 
the  community,  although  these  poor  persons  may  have  their  legal  settle- 
ment elsewhere. 

(IV)  Reimbursement 

The  Boston  City  Hospital  sends  bills  for  patients  it  treats  to  the  cities 
or  towns  in  which  they  are  supposed  to  have  a  settlement.  The  Hospital 
also  receives  from  the  State  of  Massachusetts  reimbursement  for  the  board 
of  patients.  In  the  year  ended  January  31,  1913,  this  Hospital  received 
$29,596  from  the  State  for  the  board  of  patients,  and  $24,512  from  the 
cities  and  towns  for  the  board  of  patients,  or  a  total  of  $54,108. 

Bellevue  Hospital,  in  the  City  of  New  York,  which  had  approximately 
four  times  as  many  admissions  as  the  Boston  City  Hospital,  received  in 
the  year  1912  no  payments  whatever  from  State  funds  for  persons  with 
less  than  sixty  days  residence  in  the  State,  and  received  no  reimburse- 
ment from  the  other  cities  and  towns  for  persons  having  legal  settlements 
in  them.  A  small  amount  of  money  was  transmitted  to  Bellevue  Hospital 
by  checks  of  the  State  Board  of  Charities  for  alien  patients  in  this  Hos- 
pital, but  this  money  had  been  forwarded  to  the  State  Board  of  Charities 
by  the  United  States  Government,  and  was  not  a  State  expenditure. 

If  the  law  provided  for  payments  to  Bellevue  Hospital  from  the  State, 
and  from  the  county  overseers  of  the  poor,  as  provided  in  Massachusetts, 
and  if  the  payments  for  such  patients  bore  the  same  proportion  to  the 
admissions  as  in  the  Boston  City  Hospital,  Bellevue  would  receive  approxi- 
mately $200,000  a  year  from  the  State  and  localities  within  it. 


SOME  PREVIOUS  PRESENTATIONS  AND  LEGISLATIVE 
PROVISIONS 

Aliens 

For  the  last  lOO  years  there  has  been  more  or  less  agitation  regarding 
the  presence  of  aliens  in  the  State  and  City  of  New  York  whose  mainte- 
nance has  been  provided  for  out  of  the  City's  treasury. 

As  early  as  the  year  1769  a  "pesthouse"  was  estabHshed  in  New  York 
City,  "especially  for  the  reception  of  diseased  immigrants."  Because  a 
very  large  proportion  of  immigrants  to  this  country  have  entered  through 
the  Port  of  New  York,  the  pressure  upon  this  City  has  naturally  been  pro- 
nounced. Not  only  have  the  diseased  immigrants  been  a  burden  upon  our 
municipality,  but  the  destitute  and  unemployed  have  entered  our  municipal 
institutions  in  large  numbers.  At  various  times  the  proportion  of  aliens  in 
our  charitable  institutions  has  been  reported  by  public  officials.  Fre- 
quently, however,  it  has  appeared  that  the  institutions  have  not  distin- 
guished between  foreign  born  dependents  who  had  become  naturalized  citi- 
zens and  those  who  were  still  citizens  of  other  countries. 

Foreign  Bom  in  Mimicipal  Institutions 

The  Annual  Report  of  the  Commissioner-General  of  Immigration  for 
the  year  ended  June  30,  19 12,  shows  that,  of  a  total  immigration  of  838,172 
persons,  239,275,  or  28.5  per  cent,  of  the  total,  were  aliens  who  had  de- 
clared their  intention  of  establishing  their  permanent  residence  within  the 
State  of  New  York.  The  average  proportion  of  this  class  for  the  8  years 
ended  at  the  same  date  is  over  30  per  cent.  The  mental  and  physical  ability 
of  these  intended  residents  is  a  matter  of  fundamental  concern  to  the  City. 

Many  thousands  of  the  immigrants  to  this  country  have  found  their  way 
into  the  charitable  institutions  of  this  community  and  have  been  main- 
tained at  public  expense.  According  to  the  Forty-fifth  Annual  Report  of 
the  State  Board  of  Charities,  for  the  year  ending  September  30,  191 1,  there 
were  supported  in  the  institutions  of  the  Department  of  Public  Charities, 
exclusive  of  the  Municipal  Lodging  House,  a  total  of  28,585  foreign-bom 
dependents,  or  52  per  cent,  of  the  entire  number  supported  during  the  year. 
In  the  same  year  there  were  25,835  foreign  born  patients  in  the  hospitals 
of  the  Department  of  Bellevue  and  Allied  Hospitals,  who  formed  49  per 
cent,  of  the  total  patients  maintained  in  these  institutions  in  this  year.  In 
other  words,  in  the  institutions  within  these  two  Departments  there  was  a 
total  of  54,420  foreign  born  dependents,  who  were  50  per  cent,  of  the  en- 
tire number  maintained  in  these  institutions  during  this  year.  (Pages  108 
and  no  of  Appendix  to  Volume  I,  State  Board  of  Charities  Annual  Report 
for  191 1.) 

The  Report  of  the  Commission  of  Immigration  of  the  State  of  New 
York,  appointed  by  Governor  Hughes,  transmitted  to  the  Legislature  April 
5,  1909,  stated  that  90,776  foreign  born  poor  persons  were  relieved  in  the 
several  counties  of  this  State  during  the  year  ended  September  30,  1907, 
who  constituted  44.2  per  cent,  of  the  entire  number  of  public  beneficiaries 
so  relieved  whose  nativity  could  be  determined.  (See  page  186  of  that 
Report.)    Were  the  proportion  of  foreign  born  among  those  whose  nativity 

"5 


Il6  HOSPITAL   COMMITTEE 

could  not  be  determined  the  same  as  among  those  that  could  be  classified 
according  to  nativity,  the  number  of  foreign  born  poor  persons  relieved  in 
the  counties  of  Nevi^  York  State  during  that  year  would  have  been  104,448. 
According  to  the  Appendix  (page  201)  of  the  Report  just  referred  to, 
8,215  foreign  born  lodgers  were  admitted  during  the  lirst  quarter  of  1908 
to  the  Municipal  Lodging  House,  New  York  City,  who  constituted  53.8  per 
cent,  of  the  total  admissions  in  that  period.  Including  the  native  born,  23.5 
per  cent,  of  the  total  admissions  in  this  period  had  been  in  the  City  60  days 
and  less.  It  is  not  stated  how  many  of  the  foreign  born  dependents  had 
become  naturalized. 

Table  I,  on  page  74,  shows  the  foreign  born  admissions  to  the  institu- 
tions in  the  Departments  of  Charities  and  Bellevue  and  Allied  Hospitals 
in  the  year  191 1  to  have  been  120,152.  The  admissions  to  the  New  York 
Children's  Hospitals  and  Schools  are  not  entered  in  this  table,  as  the  na- 
tivity of  its  inmates  does  not  appear  in  connection  with  its  section  in  the 
Annual  Report  of  the  Department  of  Public  Charities.  A  study  of  this 
table  shows  that  the  admissions  of  foreign  born  to  the  almshouses  were 
70  per  cent.,  65  per  cent.,  and  63  per  cent,  of  the  total  number  of  admis- 
sions in  the  Manhattan,  Brooklyn,  and  Richmond  almshouses,  respectively. 
The  Manhattan  hospitals  of  this  Department  come  next  in  proportion  of 
foreign  born,  the  proportion  in  City  Hospital  having  been  59  per  cent,  of 
the  total  admissions,  while  Metropolitan  Hospital  had  55  per  cent,  of  for- 
eign born.  The  percentage  in  the  Brooklyn  hospitals  was  much  lower,  hav- 
ing been  40  per  cent,  in  Kings  County  Hospital;  34  per  cent,  in  Coney 
Island  Hospital ;  32  per  cent,  in  Bradford  Street  Hospital ;  and  25  per  cent, 
in  Cumberland  Street  Hospital.  The  general  average  of  foreign  born  in 
almshouses  in  this  Department  was  67  per  cent.,  and  in  the  hospitals  47 
per  cent.  The  Municipal  Lodging  House  showed  a  proportion  of  43  per 
cent,  foreign  born. 

Similarly,  Bellevue  and  Allied  Hospitals  were  found  to  have  had  50  per 
cent,  of  their  total  admissions  composed  of  foreign  born  patients.  The 
total  number  of  admissions  of  foreign  born  involved  was  2-„~2,j.  The  pro- 
portion of  foreign  born  varied  between  40  per  cent,  of  the  total  admissions 
to  Harlem  Hospital,  and  62  per  cent,  of  the  total  admissions  to  Gouverneur 
Hospital ;  Fordham  Hospital,  with  42  per  cent.,  and  Bellevue  Hospital,  with 
52  per  cent.,  coming  within  those  percentages. 

There  were  42,038  admissions  of  foreign  born  patients  to  the  hospitals 
in  these  two  Departments  during  this  year,  which  number  formed  49  per 
cent,  of  the  total  admissions  to  these  institutions.  These  figures  are  taken 
from  the  Annual  Reports  of  these  institutions,  but,  unfortunately,  it  is  not 
known  what  proportion  of  these  foreign  born  had  been  naturalized. 

The  Federal  Immigration  Commission  made  an  examination  of  the  pa- 
tients admitted  to  Bellevue  and  Allied  Hospitals  during  the  7  months 
period  from  August  i,  1908,  to  February  28,  1909.  Of  the  total  of  23,758 
charity  cases  covered  by  the  investigation,  12,426,  or  51.5  per  cent.,  were  of 
foreign  birth,  and  were  maintained  by  the  City,  as  was  estimated,  at  an 
expense  of  $257,761.  Under  this  same  investigation  it  was  found  that  28 
per  cent,  of  these  foreign  born  patients  had  been  in  the  United  States  less 
than  5  years,  and  17.9  per  cent,  were  admissions  of  foreign  born  who  had 
been  in  the  United  States  less  than  3  years. 

The  proportion  of  foreign  born  patients  within  this  Department  has  not 
varied  greatly  for  some  years,  according  to  the  Annual  Reports"  of  the  De- 
partment, there  having  been  53  per  cent,  in  1908 ;  52  per  cent,  in  1909 ;  the 


ALIENS  AND   NON-RESIDENTS  II7 

same  proportion  in  1910;  50  per  cent,  in  191 1;  and  49  per  cent,  in  1912; 
Neither  the  tables  of  the  Immigration  Commission  nor  the  records  of  the 
Hospital  give  an  indication  as  to  what  proportion  of  these  foreign-born 
patients  were  citizens  of  the  United  States. 

Exclusion  of  Aliens 

By  the  United  States  Immigration  Law,  Act  of  February  20,  1907,  it 
was  enacted  that  certain  classes  of  aliens  should  be  excluded  from  admis- 
sion into  the  United  States. 

That  some  protection  is  afforded  to  this  community  by  the  United  States 
Government  may  be  inferred  from  the  report  of  the  Commissioner-General 
of  Immigration  regarding  the  number  of  aliens  debarred  from  entering  the 
country.  These  amounted  to  16,057  individuals  in  the  year  1912,  a  smaller 
number  than  was  excluded  in  either  of  the  2  preceding  years.  This  report 
does  not  state  how  many  of  these  debarred  aliens  had  selected  New  York 
as  a  future  residence. 

Removal  of  Aliens 

That  many  aliens  have  become  a  burden  upon  this  State  and  community 
is  evident  from  the  reports  of  the  agencies  empowered  to  bring  about  their 
removal.  The  agencies  having  this  power  are  the  United  States  Immigra- 
tion Service,  the  New  York  State  Board  of  Charities,  the  New  York  State 
Hospital  Commission,  and  the  New  York  State  Department  of  Labor. 
These  agencies  remove  both  those  alien  dependents  who  are  found  to 
have  been  illegally  admitted  to  the  United  States,  or  to  be  illegally  with- 
in the  country,  and  also  those  who  prefer  to  be  repatriated  rather  than 
to  live  in  an  institution  among  a  strange  people.  Removal  is  not  merely  a 
relief  to  public  expenditure,  but  may  be  a  genuine  charity  to  the  dependent 
and  the  dependent's  friends. 

(a)  The  United  States  Immigration  Service 

As  a  provision  for  the  relief  of  the  dififerent  communities  of  this  coun- 
try from  what  was  considered  an  unwarranted  burden  upon  their  charity 
the  Federal  law  authorized  the  return  of  certain  classes  of  aliens  from  the 
United  States.  In  the  United  States  Immigration  Law,  Act  of  February  20, 
1907,  as  amended,  it  was  enacted: 

§  2.  That  the  following  classes  of  aliens  shall  be  excluded  from  admission 
into  the  United  States :  All  idiots,  imbeciles,  feeble-minded  persons,  epileptics,  in- 
sane persons,  and  persons  who  have  been  insane  within  five  years  previous;  persons 
who  have  had  two  or  more  attacks  of  insanity  at  any  time  previously ;  paupers ; 
persons  likely  to  become  a  public  charge ;  professional  beggars ;  persons  afflicted 
with  tuberculosis  or  with  a  loathsome  or  dangerous  contagious  disease ;  persons  not 
comprehended  within  any  ofthe  foregoing  excluded  classes  who  are  found  to  be  and 
are  certified  by  the  examining  surgeon  as  being  mentally  or  physically  defective, 
such  mental  or  physical  defect  being  of  a  nature  which  may  affect  the  ability  of 
such  alien  to  earn  a  living;     .    .    . 

§  3.  That  .  .  .  any  alien  who  shall  be  found  an  inmate  of  ...  a  house 
of  prostitution  or  practicing  prostitution  after  such  alien  shall  have  entered  the 
United  States,  ...  or  who  is  employed  by,  in,  or  in  connection  with  any  house 
of  prostitution  or  music  or  dance  hall  or  other  place  of  amusement  or  resort 
habitually  frequented  by  prostitutes,  or  where  prostitutes  gather,  .  .  .  shall  be 
deemed  to  be  unlawfully  within  the  United  States  and  shall  be  deported  in  the 
manner  provided  by  sections  twenty  and  twenty-one  of  this  Act    .    .    . 


Il8  HOSPITAL   COMMITTEE 

%  19.  That  all  aliens  brought  to  this  country  in  violation  of  law  shall,  if  prac- 
ticable, be  immediately  sent  back  to  the  country  whence  they  respectively  came  on 
the  vessels  bringing  them.  The  cost  of  their  maintenance  while  on  land,  as  well 
as  the  expense  of  the  return  of  such  aliens,  shall  be  borne  by  the  owner  or  owners 
of  the  vessels  on  which  they  respectively  came;    .    .     . 

§  20.  That  any  alien  who  shall  enter  the  United  States  in  violation  of  the  law, 
and  such  as  become  public  charges  from  causes  existing  prior  to  landing,  shall, 
upon  the  warrant  of  the  Secretary  of  Commerce  and  Labor,  be  taken  into  custody 
and  deported  to  the  country  whence  he  came  at  any  time  within  three  years  after 
the  date  of  his  entry  into  the  United  States.  Such  deportation,  including  one-half 
of  the  entire  cost  of  removal  to  the  port  of  deportation,  shall  be  at  the  expense 
of  the  contractor,  procurer,  or  other  person  by  whom  the  alien  was  unlawfully  in- 
duced to  enter  the  United  States,  or,  if  that  cannot  be  done,  then  the  cost  of 
removal  to  the  port  of  deportation  shall  be  at  the  expense  of  the  "immigrant  fund" 
provided  for  in  section  one  of  this  Act,  and  the  deportation  from  such  port  shall  be 
at  the  expense  of  the  owner  or  owners  of  such  vessel  or  transportation  line  by 
which  such  aliens   respectively  came :    .    .    . 

§  21.  That  in  case  the  Secretary  of  Commerce  and  Labor  shall  be  satisfied 
that  an  alien  has  been  found  in  the  United  States  in  violation  of  this  Act,  or  that 
an  alien  is  subject  to  deportation  under  the  provisions  of  this  Act  or  of  any  law 
of  the  United  States,  he  shall  cause  such  alien  within  the  period  of  three  years 
after  landing  or  entry  therein  to  be  taken  into  custody  and  returned  to  the  country 
whence  he  came,  as  provided  by  section  twenty  of  this  Act,    .    .     . 

By  a  regfulation  of  the  Bureau  of  Immigration  and  Naturalization  of 
the  Department  of  Commerce  and  Labor,  in  force  in  1907,  the  following 
provision  was  made  for  the  deportation  of  aliens  who  had  become  public 
charges  from  causes  arising  subsequent  to  landing: 

Rule  39.  Deportation  by  consent. — Any  alien  who  has  been  lawfully  landed, 
but  who  has  become  a  public  charge  from  subsequently  arising  physical  inability  to 
earn  a  living,  may,  by  consent  of  the  alien  and  with  the  approval  of  the  Bureau 
of  Immigration  and  Naturalization,  be  deported  within  one  year  from  date  of 
landing  at  the  expense  of  the  immigration  fund:  Provided,  that  such  alien  is  de- 
livered to  the  immigration  officers  at  a  designated  port  free  of  charge ;  and  the 
charges  incurred  for  the  care  and  treatment  of  any  such  alien  in  any  public  or 
charitable  institution  from  the  date  of  notification  to  an  oflScer  of  the  Bureau 
until  the  expiration  of  one  year  after  landing  may  be  paid  from  the  immigration 
fund  at  fixed  rates  agreed  upon. 

{h)  The  State  Board  of  Charities 
Although  the  Federal  Government's  power  of  removal  of  an  alien  im- 
properly admitted  to  the  United  States  ceases  after  he  has  been  in  the  coun- 
try for  3  years,  we  find  no  such  limitation  in  the  following  provision  of 
the  State  law  that  confers  upon  the  State  Board  of  Charities  authority  for 
removals : 

State  Charities  Law,  constituting  chapter  55  of  the  Consolidated  Laws. 

§  17.  State,  non-resident,  and  alien  poor.  .  .  _ .  The  State  Board  of  Charities, 
and  any  of  its  members  or  officers,  may,  at  any  time,  visit  and  inspect  any  institu- 
tion subject  to  its  supervision  to  ascertain  if  any  inmates  supported  therein  at  a 
state,  county  or  municipal  expense  are  State  charges,  non-residents  or  alien  poor; 
and  it  may  cause  to  be  removed  to  the  state  or  country  from  which  he  came  any 
such  non-resident  or  alien  poor   found  in  any  such  institution. 

(c)  The  State  Hospital  Commission 
The  Insanity  Law,  as  amended  in  January,  1912,  Chapter  27  of  the 
Consolidated  Laws,  provides: 

First:  That  such  Bureau'  shall  examine  and  inspect  alien  and  non-residei}t 
insane  persons,  and  alleged  insane  persons  in  the  State  hospitals,  other  public  insti- 

'  Otherwise  known  as  the  State  Board  of  Alienists. 


ALIENS  AND  NON-RESIDENTS  1 19 

tutions  and  elsewhere  where  such  insane  persons  and  alleged  insane  persons  may 
be  for  the  purpose  of  determining  whether  they  are  suitable  cases  for  deportation 
under  the  immigration  law,  or  removal  under  the  provisions  of  this  section  to  other 
countries  or  states,  and  shall  notify  the  proper  authorities  having  control  of  the 
enforcement  of  the  immigration  laws  at  the  ports  of  entry  of  such  immigrants  as 
are  found  to  be  insane,  idiotic,  imbecile  or  epileptic,  and  such  insane  aliens  as  are 
or  become  public  charges,  or  who  are  in  the  country  in  violation  of  law,  and  shall 
arrange  for  their  deportation  in  accordance  with  the  provisions  of  such  laws. 

Second :  The  bureau  may,  upon  the  request  of  any  indigent  insane  person,  or 
the  written  consent  of  their  relatives,  legal  representatives,  or  qualified  friends,  sub- 
ject to  the  approval  of  the  Commission,  remove  such  patients  to  any  country,  state 
or  place  to  which  they  may  properly  belong.  .    .   ^         .    .        , 

—Report  of  Bureau  of  Deportation  to  the  State  Hospital  Commission  for 
year  ending  September  30,  1912. 

(d)  Bureau  of  Industries  and  Immigration,  New  York  State  Department 

of  Labor 

The  power  for  the  other  agency  of  removal  was  given  as  follows : 

New  York  State  Laws  of  1910,  Chapter  514, 
Article  loA. 

Section  153,  Subd.  4.  The  commissioner  of  labor  may  .  .  .  secure  informa- 
tion with  respect  to  such  aliens  who  shall  be  in  prisons,  almshouses  and  insane 
asylums  of  the  State,  and  who  shall  be  deportable  under  the  laws  of  the  United 
States,  and  co-operate  with  the  Federal  authorities  and  with  such  officials  of  the 
State  having  jurisdiction  over  such  criminals,  paupers  and  insane  aliens  who  shall 
be  confined  as  aforesaid,  so  as  to  facilitate  the  deportation  of  such  persons  as  shall 
come  within  the  provisions  of  the  aforesaid  laws  of  the  United  States,  relating 
to  deportation.    .    .    . 

The  New  York  State  Bureau  of  Industries  and  Immigration  of  the 
State  Department  of  Labor  did  little  toward  relieving  the  community  and 
State  of  their  burdens,  judging  from  the  following  quotation  from  its  First 
Annual  Report,  for  the  year  ending  September  30,  191 1: 

(The  Bureau)  .  .  .  has,  therefore,  in  co-operation  with  the  State  authorities 
charged  with  these  matters,  dealt  only  with  a  few  cases  of  deportation  brought  to  its 
attention,  and  has  gathered  no  statistics. 

The  Other  two  State  bodies  cooperate  with  the  United  States  Immigra- 
tion Service,  making  the  preliminary  investigations  and  referring  the  cases 
to  the  Government  for  action.  Many  of  the  deportations  reported  by  the 
State  bodies  are  duplicated  in  the  number  reported  by  the  United  States 
authorities.  The  cooperation  between  the  State  and  Government  authori- 
ties is  very  important  in  making  the  work  of  the  State  bodies  effective. 
Though  empowered  by  State  laws  to  take  steps  toward  removal,  the  power 
of  the  State  Boards  stops  at  the  boundary  line  of  the  State.  The  control 
over  the  steamship  companies  pertains  to  the  Federal  Government,  and  it  is 
under  its  compulsion  that  unwilling  transportation  companies  carry  aliens, 
illegally  in  this  country,  to  their  native  lands. 

The  relief  afforded  the  City  by  the  marked  activity  of  the  State  Board 
of  Alienists  in  recent  years  has  been  indirect,  rather  than  direct,  as  a  large 
majority  of  the  removals  effected  through  this  Board  occur  after  the  aliens 
have  been  committed  to  State  institutions.  The  State  Board  of  Alienists, 
however,  according  to  its  annual  reports,  has  been  effective  in  returning  a 


I20  HOSPITAL   COMMITTEE 

higher  yearly  average  of  aliens  during  the  period  of  its  existence  than  the 
State  Board  of  Charities,  the  average  number  of  alien  removals  on  the  part 
of  the  State  Board  of  Alienists  having  been  about  500  cases  annually,  while 
for  the  33  years  from  1880  to  1912  the  State  Board  of  Charities  has  aver- 
aged only  266  removals  a  year.  It  is  not  known  what  proportion  of  the 
removals  by  the  State  Boards  have  been  from  the  City  of  New  York. 

As  will  be  seen  by  reference  to  Table  II,  according  to  the  Annual  Re- 
ports of  the  Department  of  Public  Charities  for  the  years  from  1902  to 
1905,  inclusive,  2,369  aliens  were  transferred  in  these  4  years  by  the 
Department  of  Public  Charities  to  the  Commissioners  of  Immigration 
from  New  York  City  alone.  This  number  was  over  2,000  in  excess  of  the 
total  number  of  removals  from  the  entire  State  of  New  York,  including 
New  York  City,  by  the  Department  of  State  and  Alien  Poor  of  the  State 
Board  of  Charities  in  the  same  years.  Although  the  number  of  these  re- 
movals by  the  Department  of  Charities  diminished  yearly,  from  1,137  ^^ 
1902  to  861  in  1903,  328  in  1904,  and  to  only  43  in  1905,  the  average  yearly 
number  of  removals  by  this  Department  exclusively  from  this  City  for 
these  4  years  was  592,  as  compared  with  the  yearly  average  of  91  for  the 
same  years,  and  of  420  for  the  10  years  from  1902  to  191 1,  inclusive,  by  the 
State  Board  of  Charities  from  the  entire  State,  including  the  City  of  New 
York.  The  direct  removal  of  aliens  by  the  Department  of  Public  Charities 
to  the  Commissioners  of  Immigration  appears  to  have  ceased  with  the  year 
1905,  as  no  entries  of  such  removals  are  found  in  its  Annual  Reports  after 
that  year. 

Non-Residents 

(a)  Non-Residents  of  New  York  State 

As  a  matter  of  general  practice  the  State  makes  no  provision  for  the 
exclusion  of  residents  of  other  states  from  its  confines,  although  its  laws 
make  it  a  misdemeanor  to  bring  any  poor  person  from  without  the  State  to 
make  him  wrongfully  chargeable  upon  any  county  or  town  in  the  State, 
or  upon  the  State  itself. 

There  are,  however,  powers,  additional  to  those  for  the  removal  of  aliens, 
conferred  upon  two  of  the  State  bodies;  namely,  the  State  Board  of  Chari- 
ties, and  the  State  Board  of  Alienists.  These  powers  provide  for  the  re- 
moval of  dependents  who  have  not  established  a  legal  settlement  in  New 
York  State  to  the  other  states  from  which  they  have  come.  The  easy 
accessibility  of  this  State,  especially  this  City,  from  the  neighboring  states 
has  made  it  possible  for  many  who  should  not  properly  be  dependents 
within  the  State  to  come,  or  be  sent,  here  and  to  become  public  charges  upon 
the  municipality.  As  these  adjoining  states  do  not  have  boards  of  central 
control  authorized  to  receive  non-residents  of  other  states  for  return  to 
the  places  of  their  legal  settlement,  our  authorities  whose  business  it  is  to 
remove  improper  residents  of  charitable  institutions  have  not  always  found 
a  ready  acceptance  of  the  non-residents  of  New  York  State  that  they  de- 
sire to  return  to  adjoining  states.  Again,  the  laws  of  the  adjoining  states 
defining  the  settlement  which  a  poor,  sick,  or  insane  person  must  have  to 
be  eligible  for  maintenance  in  a  state,  county,  or  town  institution  vary  from 
those  of  New  York  State.  On  account  of  this  lack  of  uniformity,  the 
authorities  within  this  State  are  not  infrequently  unable  to  find  support  for 
their  requests  for  the  acceptance  of  non-residents  of  New  York  State  in  the 
law  of  other  states. 


ALIENS  AND   NON-RESIDENTS  121 

(b)  Non-Residents  of  New  York  City 

The  basis  of  deciding  upon  what  officials  falls  the  responsibility  for  the 
maintenance  of  a  poor  person  is  the  settlement  of  the  applicant  for  relief. 
The  general  statement  regarding  this  settlement  is  found  in  the  following 
section  of  the  Poor  Law : 

ARTICLE  4- 

§  40.  Settlements,  how  gained.  Every  person  of  full  age,  who  shall  be  a  resi- 
dent and  inhabitant  of  any  town  or  city  for  one  year,  and  the  members  of  his  family 
who  shall  not  have  gained  a  separate  settlement,  shall  be  deemed  settled  in  such 
town  or  city,  and  shall  so  remain  until  he  shall  have  gained  a  like  settlement  in 
some  other  town  or  city  in  this  State,  or  shall  remove  from  this  State  and  remain 
therefrom  one  year.    .    .    . 

Such  a  poor  person  may  not  be  removed  from  one  locality  to  another 
within  the  State  by  the  authorities  of  the  locality  in  which  he  is  supported 
as  a  poor  person: 

§  42.  Poor  persons  not  to  be  removed,  and  how  supported.  No  person  shall 
be  removed  as  a  poor  person  from  any  city  or  town  to  any  other  city  or  town 
of  the  same  or  any  other  county,  nor  from  any  county  to  any  other  county  except 
as  hereinafter  provided;  but  every  poor  person,  except  the  state  poor,  shall  be 
supported  in  the  town  or  county  where  he  may  be,  as  follows: 

1.  If  he  has  gained  a  settlement  in  any  town  or  city  in  such  county,  he  shall 
be  maintained  by  such  town  or  city. 

2.  If  he  has  not  gained  a  settlement  in  any  town  or  city  in  the  county  in 
which  he  shall  become  poor,  sick  or  infirm,  he  shall  be  supported  and  relieved  by 
the  superintendents  of  the  poor  at  the  expense  of  the  county    .    .    . 

The  communities,  however,  into  which  an  indigent  person  may  enter  in 
search  of  relief  are  not  without  redress  from  the  burden  upon  them  of  the 
maintenance  of  such  an  individual,  as  the  following  means  of  relief  is 
afforded  them: 

§  SI.  Proceedings  to  compel  support.  A  poor  person  so  removed,  brought  or 
enticed,  or  who  shall  of  his  own  accord  come  or  stray  from  one  city,  town  or  county 
into  any  other  city,  town  or  county  not  legally  chargeable  with  his  support,  shall 
be  maintained  by  the  county  superintendents  of  the  county  where  he  may  be. 
They  may  give  notice  to  either  of  the  overseers  of  the  poor  of  the  town  or  city 
from  which  he  was  brought  or  enticed,  or  came  as  aforesaid,  if  such  town  or  city 
be  liable  for  his  support,  and  if  there  be  no  town  or  city  in  the  county  from 
which  he  was  brought  or  enticed  or  came,  liable  for  his  support,  then  to  either  of 
the  county  superintendents  of  the  poor  of  such  county,  within  ten  days  after 
acquiring  knowledge  of  such  improper  removal,  informing  them  of  such  improper 
removal,  and  requiring  them  forthwith  to  take  charge  of  such  poor  person.    .     .    . 

This  section  of  the  Poor  Law  has  been  interpreted  to  apply  only  to  per- 
sons whose  dependence  begins  after  leaving  the  places  of  their  settlement, 
according  to  the  following  extract  from  the  State  Board  of  Qiarities  Re- 
port for  1911,  Vol.  Ill,  page  351 : 

Held  that,  when  a  person  becomes  a  "poor  person"  after  he  has  left  the  town  or 
county  in  which  he  has  gained  a  settlement,  he  must  be  supported  by  the  county  in 
which  he  becomes  a  poor  person,  without  right  on  the  part  of  such  county  to  reim- 
bursement from  the  town  or  county  from  which  he  came,  even  though  his  settle- 
ment still  remains  there.  Supreme  Court,  App.  Div.,  May  3,  1905,  Delaware  County 
V.  Town  of  Delaware,  Sullivan  County,  93  N.  Y.  Supp.  934. 

By  the  above  interpretation  it  will  be  seen  that  the  town  or  county  poor 
authorities  have  not  equal  opportunity  of  relieving  their  communities  of  the 
maintenance  of  a  dependent  whose  settlement  is  in  another  county  or  town 


122  HOSPITAL   COMMITTEE 

in  this  State,  with  that  which  they  have  of  relieving  them  in  the  case  of  a 
dependent  with  settlement  outside  of  the  State.  According  to  this  render- 
ing of  the  law  the  burden  can  be  put  upon  the  place  of  his  settlement  only 
in  the  case  of  a  dependent  who  was  a  "poor  person"  in  the  locality  of  his 
settlement  prior  to  his  coming  to  the  community  which  desires  relief,  where- 
as, all  dependents  who  have  not  established  a  settlement  within  this 
State  may,  within  the  discretion  of  the  State  Board  of  Charities,  be  re- 
moved to  the  states  from  which  they  came. 

State  Poor 

The  recognition  of  the  duty  of  the  State  to  relieve  communities  of  the 
expense  of  maintaining  dependent  poor  who  have  not  established  a  legal 
settlement  in  these  communities  is  expressed  in  the  following  extract  from 
the  report  of  the  Committee  on  State  and  Alien  Poor,  of  the  State  Board 
of  Charities,  in  Vol.  I  of  the  Annual  Report  of  the  Board  for  1902,  page 
351: 

To  prevent  imposition  as  far  as  possible  and  to  relieve  the  several  communities 
of  the  State  of  the  care  of  such  destitute  non-residents  is  the  special  function  of 
the  Department  of  State  and  Alien  Poor.  It  is  not  to  be  expected  that  all  persons 
who  come  to  this  State  will  prove  thrifty  and  successful.  Accidents  happen  and 
misfortune  is  common.  Too  many  people  come  with  barely  sufficient  means  to 
pay  their  transportation  to  the  State;  others,  with  more  means,  meet  with  disap- 
pointment, misfortune  or  disaster.  In  all  cases,  as  they  are  non-residents  without 
a  legal  claim  upon  a  county,  they  must  be  removed  at  the  expense  of  the  State. 
It  is  just  that  the  State  should  itself  assume  the  care  and  removal  of  persons  of 
this  character,  and  in  the  end  the  expenses  incurred  under  the  law  prove  economical. 

The  definition  of  the  class  of  dependents  for  whom  the  State  is  responsi- 
ble will  be  found  in  the  following  section  of  the  Poor  Law,  Article  7 : 

§  90.  Who  are  state  poor,  and  how  relieved.  Any  poor  person  who  shall  not 
have  resided  sixty  days  in  any  county  in  this  State  within  one  year  preceding  the 
time  of  an  application  by  him  for  aid  to  any  superintendent  or  overseer  of  the 
poor,  or  other  officer  charged  with  the  support  and  relief  of  poor  persons,  shall 
be  deemed  to  be  a  state  poor  person,  and  shall  be  maintained  as  in  this  article 
provided.  The  state  board  of  charities  shall,  from  time  to  time,  on  behalf  of 
the  state,  contract  for  such  time,  and  on  such  terms  as  it  may  deem  proper,  with  the 
authorities  of  not  more  than  fifteen  counties  or  cities  of  this  State,  for  the  reception 
and  support,  in  the  almshouses  of  such  counties  or  cities  respectively,  of  such  poor 
persons  as  may  be  committed  thereto. 

The  following  quotation  from  the  law  prescribes  the  method  of  mainte- 
nance of  such  persons : 

§  92.  State  poor  to  be  conveyed  to  state  almshouse.  County  superintendents 
of  the  poor,  or  officers  exercising  like  powers,  on  satisfactory  proof  being  made 
that  the  person  so  applying  for  relief  as  a  State  poor  person,  as  defined  by  this 
chapter,  is  such  poor  person,  shall,  by  a  warrant  issued  to  any  proper  person  or 
officer,  cause  such  person,  if  not  a  child  under  sixteen  years  of  age,  to  be  conveyed 
to  the  nearest  state  almshouse,  where  he  shall  be  maintained  until  duly  dis- 
charged,   .    .    . 

Though  the  law  gives  a  specific  definition  of  State  poor  persons,  the 
impracticability  in  New  York  City  of  its  requirement  that  these  shall  be 
maintained  in  the  State  Almshouses  is  evident. 

The  number  of  State  Poor  committed  to  all  the  almshouses  of  fhe 
State  will  be  found  in  Table  III.  From  this  table  it  will  be  learned  that 
from  the  year  in  which  the  State  Poor  Law  of  1873  went  into  operation 


ALIENS  AND   NON-RESIDENTS 


123 


up  to  the  year  1899  there  was  a  general  increase  in  the  number  of  State 
Poor  committed  annually  to  the  county  or  town  almshouses  that  had  been 
designated  in  accordance  with  the  law  as  State  Almshouses,  after  contract 
with  the  county  and  town  authorities.  The  total  number  of  State  Poor  com- 
mitted in  1874  was  563,  and  in  1899  it  was  2,049.  The  average  number 
of  commitments  for  the  first  4  years  of  this  period  in  the  entire  State,  in- 
cluding New  York  City,  was  680.  The  average  number  in  the  next  8  years 
was  1,498,  which  was  818  more  than  in  the  first  4  years.  The  average 
number  for  the  next  8  years,  from  1886  to  1893,  inclusive,  was  1,528,  a  dif- 
ference of  only  30  from  the  preceding  8  years.  The  height  of  responsi- 
bility accepted  by  the  State  for  the  relief  of  the  various  communities  from 
the  care  of  State  Poor  was  reached  in  the  next  6  years,  during  which  there 
was  a  yearly  average  of  2,014  State  Poor  committed  to  the  different  alms- 
houses in  the  State.  A  general  decline  in  the  number  of  State  Poor  main- 
tained as  proper  burdens  upon  the  State  is  noticeable  in  the  table  from 
this  time  on. 

The  average  for  the  next  5  years,  from  1900  to  1904,  was  1,538.  An 
explanation  of  the  falling  off  in  the  commitment  of  State  Poor  is  given  in 
the  report  of  the  Committee  on  State  and  Alien  Poor,  in  Vol.  I  of  the  Re- 
port of  the  State  Board  of  Charities  for  1904,  on  page  374: 

The  commitment  of  State  Poor  during  the  past  year  has  fallen  off  to  some 
extent,  as  compared  with  previous  years.  The  time  of  maintenance  has  also  been 
shortened.  These  two  things  are  due  to  the  rigid  inquiries  made  into  the  history  of 
all  applicants  for  relief  as  State  Poor  persons.  Many  such  have  been  rejected 
after  primary  examination  and  others  after  an  interview  by  the  agent  or  inspector 
of  the  department. 

Although  the  decline  for  the  years  from  1900  to  1904  was  marked,  it  is 
far  less  marked  than  the  decline  in  the  7  years  Succeeding,  1905  to  191 1, 
during  which  time  the  average  number  committed  annually  by  the  State  as 
State  Poor  was  575.  Thus,  it  will  be  seen  that  during  the  7  years  ending 
with  191 1,  30  years  after  the  State  Poor  Law  went  into  operation,  while 
the  burdens  of  the  municipalities  had  increased  tremendously,  the  State 
maintained  as  charges  upon  itself  an  annual  average  15  per  cent,  smaller 
than  it  maintained  during  the  first  4  years  beginning  with  1874. 

Not  only  is  this  true,  but  in  the  10  years  from  1902  to  191 1  inclu- 
sive there  was  a  marked  decrease  in  the  sums  paid  by  the  State  Board 
of  Charities  for  the  maintenance  of  State  Poor  under  contract  in  the  alms- 
houses in  the  State.  From  Table  XLVII  it  may  be  learned  that  this  sum 
diminished  from  nearly  $13,000  in  1902  to  less  than  $5,500  in  191 1. 

Report  of  the  Superintendent  of  the  State  and  Alien  Poor  of  the  State  Board 
of  Charities 

The  following  extract  from  this  report  for  the  year  ending  September 
30,  191 1,  is  found  in  the  Annual  Report  of  the  State  Board  of  Charities  for 
1911,  Vol.  I.,  page  287: 

The  Superintendent  of  State  and  Alien  Poor  is  appointed  by  the  State  Board 
of  Charities,  under  chapter  55  of  the  Consolidated  Laws,  which  requires  him  to 
visit,  either  in  person  or  by  representative,  each  State  almshouse  at  least  once 
every  three  months,  and  to  examine  into  the  condition  and  needs  of  all  State 
poor  persons.  It  is  his  further  duty  to  provide,  when  practicable,  for  the  return 
to  their  legal  residence  of  all  aliens  and  non-residents  committed  as  poor  persons  to 
public  charitable  institutions.  He  has  complied  with  the  requirements  of  the  law 
during  the  past  fiscal  year,  and  made  the  investigations  and  inspections  regularly. 


124  HOSPITAL   COMMITTEE 

Another  extract  from  the  same  volume,  on  page  285,  from  tlie  report 
of  the  Committee  on  State  and  Alien  Poor  is  as  follows : 

The  inspection  of  almshouses,  public  hospitals  and  similar  institutions  is  an 
important  part  of  the  work,  and  the  Board's  inspectors  annually  visit  all  such  institu- 
tions and  make  careful  examination,  noting  improvements  as  well  as  defects.  These 
inspectors  also  examine  such  aliens  and  non-resident  poor  as  may  be  found  in 
public  institutions  and  in  others  maintained  at  public  expense  and  make  report 
thereon  to  the  Superintendent.  A  careful  physical  examination,  attested  by  the 
attending  physician,  enables  the  Superintendent  to  determine  whether  such  de- 
pendents are  likely  to  be  a  permanent  charge  upon  the  public  or  will  be  able  to 
become  self-supporting.  In  the  first  instance,  unless  special  reasons  suggest  different 
action,  the  aliens  and  non-residents  are  returned  to  their  proper  legal  residence. 
In  the  latter  instance,  they  are  discharged  to  take  care  of  themselves  when  able 
to  do  so.  The  aliens  found  are  usually  reported  to  the  United  States  Commissioners 
of  Immigration,  who,  when  possible,  cooperate  with  the  Department  in  their  removal 
to  foreign  lands. 

A  compilation  of  the  work  of  the  Department  of  State  and  Alien  Poor 
for  the  year  ended  September  30,  1912,  as  it  affected  New  York  City  will 
be  found  in  Table  XLIV.  The  figures  in  this  table  were  gathered  from 
the  monthly  reports  of  this  Department  of  the  State  Board  of  Charities  to 
the  Departments  of  Public  Charities  and  Bellevue  and  Allied  Hospitals.  It 
will  be  seen  from  this  table  that  of  the  total  number  of  1,353  removals  from 
this  City  during  the  year  named,  877,  or  64.8  per  cent.,  were  from  the  De- 
partment of  Public  Charities;  232,  or  17. i  per  cent.,  were  from  Bellevue 
and  Allied  Hospitals;  183,  or  13.5  per  cent.,  frorn  numerous  private  insti- 
tutions; 21,  or  1.6  per  cent.,  were  from  two  State  hospitals  for  the  insane; 
9,  or  .7  per  cent.,  were  from  two  hospitals  of  the  Department  of  Health ; 
and  31,  or  2.3  per  cent.,  were,  from  institutions  not  named  in  these  reports. 
This  Department  of  the  State  Board  of  Charities  included  in  its  reports  of 
removals  some  cases  which  were  actually  removed  by  the  United  States 
Immigration  Service,  to  which,  however,  the  attention  of  the  United  States 
authorities  was  called  by  the  State  Board  of  Charities.  These  removals 
by  the  United  States  officials  totaled  44  during  this  year,  and  the  majority  of 
these  came  from  the  Department  of  Charities.  This  number  of  removals 
by  the  United  States  is  very  small  in  comparison  with  the  688  removals  to 
other  countries  through  the  instrumentality  of  the  State  Board  of  Charities. 
Not  greatly  behind  these  removals  to  other  countries  by  the  Department  of 
State  and  Alien  Poor  are  its  removals  to  other  states,  which  totaled  621  in 
this  fiscal  year.  The  preliminary  report  of  the  State  Board  to  the  Legis- 
lature for  the  same  fiscal  year  shows  that  the  total  removals  from  the 
entire  State  through  this  Board  was  2,024.  Over  60  per  cent.,  there- 
fore, of  the  removals  from  the  entire  State  were  made  from  New  York 
City. 


ALIENS,  NON-RESIDENTS,  AND   STATE  POOR  IN  A 
MUNICIPAL  HOSPITAL 

In  order  to  make  a  test  of  the  dependents  in  the  public  charitable  insti- 
tutions of  the  City  it  seemed  well  to  select  institutions  representative  of 
two  general  classes;  namely,  hospitals  and  almshouses.  Bellevue  Hospital 
was  selected  for  the  examination  of  its  patients,  for  the  purpose  of  ascer- 
taining, as  far  as  practicable,  what  aliens,  non-residents,  and  State  Poor 
were  maintained  and  treated  at  the  City's  expense. 

In  the  City  of  New  York,  in  accordance  with  the  general  provisions  of 
the  Poor  Law,  it  is  specifically  stated  in  the  section  of  the  Charter  dealing 
with  the  Department  of  Public  Charities  that : 

The  Commissioner  shall  be  the  overseer  of  the  poor  of  New  York,  as  consti- 
tuted by  this  Act. 

While  the  hospitals  now  incorporated  in  the  Department  of  Bellevue 
and  Allied  Hospitals  were  in  the  Department  of  Public  Charities  they  and 
their  inmates  were  under  the  control  of  the  Commissioner,  in  his  capacity 
of  overseer  of  the  poor  of  the  City.  When,  however,  the  Department  of 
Bellevue  and  Allied  Hospitals  was  formed,  the  relation  of  the  Commissioner 
of  Public  Charities  became  only  that  of  an  ex-ofRcio  member  of  the  Board 
of  Trustees,  and  to  no  official  or  officials  was  there  given  specifically  the 
powers  of  an  overseer  of  the  poor  to  be  exercised  in  the  Department  of 
Bellevue  and  Allied  Hospitals. 

Although  there  has  been  more  or  less  activity  in  the  Department  of 
Public  Charities  since  its  creation  toward  the  relief  of  the  municipality 
from  the  maintenance  of  public  charges  properly  belonging  upon  some 
other  locality,  and  many  such  improper  charges  have  been  removed  from 
the  City,  practically  no  attention  was  paid  to  this  matter  by  the  Board  of 
Trustees  of  Bellevue  and  Allied  Hospitals  until  the  year  1910. 

Examination  of  Records  of  Bellevue  Hospital  for  1912 

An  examination  of  the  records  of  Bellevue  Hospital  for  the  year  1912 
showed  that  a  large  number  of  public  charges  belonging  to  the  three  classes 
of  aliens,  non-residents,  and  State  poor,  had  been  allowed  to  enter  this  insti- 
tution freely.  The  comparatively  newly  aroused  interest  of  the  authorities 
in  control  was  found  to  have  produced  results  in  the  removal  of  a  small 
proportion  of  the  patients  treated  within  this  institution  in  this  year;  also 
in  the  collection  of  the  small  sum  of  approximately  a  thousand  dollars 
from  patients  who,  had  their  treatment  not  been  paid  for,  would  otherwise 
have  fallen  into  one  of  these  three  classes  of  poor  persons. 

The  records  of  the  Hospital  show  that  in  this  year  there  were  2,431 
admissions  of  patients  who  had  lived  in  New  York  City  less  than  i  year, 
and  who,  therefore,  had  no  established  settlement  in  this  City  as  defined  in 
the  Poor  Law,  and  that  these  patients  received  26,297  days  of  treatment, 
at  a  total  estimated  expense  to  the  City  of  $47,597.57.  Receipts  amounting 
to  $1,039  were  found  to  have  been  taken  in  by  the  Hospital  in  return  for 
the  expense  of  these  patients.  Of  these  2,431  non-residents  of  the  City, 
1,426  were  aliens,  who  received  treatment  for  16,395  days,  at  an  expense 
of  $29,674.95;  while  1,005  were  citizens,  who  were  treated  9,902  days,  at  a 
cost  of  $17,922.62.     (Tables  X  and  XI.) 

125 


126  HOSPITAL  COMMITTEE 

In  addition  to  the  above  there  were  found  to  have  been  a  considerable 
number  of  aliens  admitted  to  the  Hospital  who  had  established  a  settlement 
in  the  City  but  who  had  been  in  the  United  States  less  than  3  years.  Had 
complete  records  of  the  duration  of  their  diseases  prior  to  their  admission 
been  available,  many  of  these  aliens  would  doubtless  have  been  found  to 
fall  within  the  classes  deportable  under  the  United  States  Immigration 
Laws.  The  histories,  however,  from  which  this  information  was  gathered 
did  not  give  enlightenment  on  this  point.  There  were  1,308  admissions  of 
alien  patients  of  this  class  in  the  year  1912,  who  received  15,411  days  of 
treatment,  at  an  estimated  expense  to  the  City  of  $27,913.91.     (Table  XII.) 

The  above  figures  give  only  a  partial  idea  of  the  expense  to  the  City 
for  the  maintenance  and  treatment  of  non-resident  and  alien  poor  in  this 
institution.  With  the  exception  of  the  few  included  in  the  aliens  less  than 
I  year  in  the  City,  no  account  whatever  was  taken  of  those  aliens  who  had 
been  in  the  United  States  more  than  3  years.  Many  of  these  unquestion- 
ably had  not  formed  permanent  associations  in  this  country,  and  the  nature 
of  their  sickness  would  make  deportation  proper.  In  a  number  of  these 
cases  such  an  act  would  undoubtedly  have  been  the  preference  of  the  pa- 
tients. Nevertheless,  of  the  limited  classes  considered,  there  was  a  com- 
bined total  of  3,739  patients,  maintained  for  41,708  days,  at  a  gross  estimated 
expense  to  the  City  of  $75,511.48.  Of  this  large  number  there  were  only  yy 
patients  whose  expense  was  found  to  have  been  paid  for.  The  total  amount 
of  the  payments  aggregated  $1,039,  leaving  3,662  patients  whose  expense, 
amounting  to  $74,472.48,  fell  entirely  upon  the  City.  This  amount  does 
include  a  proportion  of  the  general  administration  expense  of  the  Depart- 
ment, but  contains  none  of  the  carrying  charges  accruing  from  corporate 
stock  expenditures.    (Table  XIII.) 

The  non-residents  admitted  to  the  Hospital  in  this  year  were,  for  com- 
parison, separated  into  two  classes;  viz.,  aliens  and  citizens.  The  former 
class  seemingly  would  have  less  claim  upon  the  public  charity  of  this  coun- 
try than  the  latter.  Under  the  Charter,  specific  provision  is  made  for  the 
reception  into  this  Hospital  of  certain  non-residents  of  the  City,  as  fol- 
lows: 

TITLE  II.  Section  692.  7.  Any  person  injured  or  taken  sick  in  the  streets 
or  in  any  public  square  or  place  within  The  City  of  New  York,  who  may  not  be 
safely  removed  to  his  or  her  home,  may  be  sent  to  and  shall  be  received  by  the 
said  hospitals  for  temporary  care  and  treatment,  irrespective  of  his  or  her  place 
of  residence.  The  said  board  of  trustees  shall  provide  and  maintain  suitable  rooms 
or  wards  for  the  reception,  medical  examination  and  temporary  care  of  persons 
alleged  to  be  insane. 

The  two  kinds  of  non-residents  received  in  Bellevue  in  1912  were  di- 
vided in  reference  to  this  section  of  the  Charter  as  follows : 

Class  I. — Aliens  whose  admissions  were  authorized  by  this  section  of 
the  Charter.  Qass  II. — Aliens  whose  admissions  were  not  authorized  by 
this  section  of  the  Charter.  Class  III. — Aliens  for  whose  admissions  the 
authorization  by  this  section  of  the  Charter  was  not  evident.  And  Classes 
IV,  V,  and  VI,  consisting  of  similar  divisions  of  the  citizens.  (Tables  IV  to 
IX.) 

More  than  two-thirds  of  the  non-residents  admitted  were  found  not 
to  have  been  brought  from  some  public  place  or  street,  as  allowed  un- 
der the  Charter.  A  total  of  928  alien  non-residents  were  found  not  to  have 
been  of  this  class,  compared  with  420  that  were  (Tables  IV  and  V),  while 
626  citizens  were  not  of  this  class,  in  comparison  with  324  which  were 


ALIENS  AND   NON-RESIDENTS  127 

brought  in  as  allowed  by  the  Charter  (Tables  VII  and  VIII).  There 
were  78  aliens  and  55  citizens,  or  a  total  of  133,  of  whom  it  was  not  clear 
whether  they  were  emergency  cases  of  the  character  mentioned  in  the 
Charter  (Tables  VI  and  IX). 

It  is  apparent,  therefore,  that  this  expense  to  the  City  has  not  been 
brought  about  merely  by  accidents  or  other  emergencies  arising  in  public 
places  or  on  the  streets.  To  make  this  clear,  study  was  made  of  the  meth- 
ods by  which  these  admissions  were  made.  Of  these  2,431  non-resident 
admissions,  1,148,  about  which  the  records  gave  information  on  this  point, 
or  nearly  one-half  of  the  total,  were  admissions  of  patients  who  had  come 
on  foot  to  the  institution  for  treatment  (Table  XXXII).  Of  the  re- 
mainder, 458  were  brought  in  by  the  ambulances  belonging  to  Bellevue  and 
518  by  ambulances  belonging  to  other  hospitals,  while  in  the  cases  of  230 
the  means  by  which  the  patients  reached  the  Hospital  either  were  unknown 
or  were  different  from  those  stated. 

As  the  Charter  provides  for  the  reception  of  non-residents  who  pay 
for  their  treatment  in  the  Hospital,  the  yy  cases  who  paid  were  placed  in 
a  class  by  themselves.  An  examination  of  Table  XXVIII  will  show  that 
1,056  of  the  total  of  1,554  non-residents  that  were  admitted  to  the  Hospi- 
tal otherwise  than  as  provided  for  in  Section  692,  Subd.  7,  of  the  Charter, 
walked  to  the  door  of  the  institution  and  were  accepted  as  public  charges 
by  the  admitting  officers. 

Careful  analysis  was  made  of  all  of  these  non-residents  with  regard  to 
their  residence:  in  the  United  States,  in  the  cases  of  aliens,  and  in  New 
York  City,  in  the  cases  of  citizens.  The  statements  of  the  patients  them- 
selves, as  given  upon  admission,  were  accepted.  It  can  hardly  be  questioned 
that  these  patients  would  be  much  more  likely  to  claim  a  longer  residence  in 
a  country  or  city  than  they  really  had,  rather  than  a  shorter  one.  The  analy- 
sis, therefore,  in  the  tables  appended  should  be  an  under-estimate  rather 
than  an  over-estimate. 

These  non-residents  were  carefully  separated  into  thirteen  classes  ac- 
cording to  the  United  States  and  State  laws  for  admission  and  deporta- 
tion of  immigrants  and  the  definition  of  County,  State,  and  Town  Poor. 
Also,  a  class  was  made  of  the  patients  "Apparently  justifiable  as  City 
charges."  This  class  consisted  of  patients  for  whom  payment  was  made, 
prisoners,  insane  cases,  and  a  few  others  whose  ailments  seemed  to  be 
of  a  nature  which  would  warrant  their  being  cared  for  by  the  City,  even 
though  they  might  not  have  been  brought  from  the  street  or  some  public 
place. 

Non-Resident  Aliens 

Of  the  1,426  non-resident  aliens  ^  admitted  in  this  year,  it  was  evident 
from  the  records  that  178  had  been  improperly  admitted  to  the  United 
States.  A  few  typical  cases  of  this  class  will  be  found  on  pages  133  to 
135.  From  the  information  given  on  the  admission  and  discharge  records 
it  appeared  that  273  more  of  these  aliens  were  removable  by  the  State 
Board  of  Charities.  It  is  more  than  probable  that  a  number  of  these  cases 
had  been  improperly  admitted  to  this  country,  but  the  records  consulted 
were  not  sufficiently  full  to  demonstrate  this  fact.    These  two  classes  had 

"  Here  and  elsewhere  in  this  Report  when  a  number  of  persons  is  said  to  have 
been  admitted  to  a  City  institution  the  different  admissions  of  the  same  dependent 
were  counted  as  separate  persons  in  accordance  with  institutional  practice.  The 
actual  number  of  persons  involved  may  be  slightly  smaller  than  the  number  given. 


128  HOSPITAL   COMMITTEE 

been  given  a  total  of  6,358  days  treatment,  or  2,769  and  3,589  days,  re- 
spectively, at  a  total  expense  of  $11,507.98.     (Table  X.) 

Prominent  among  the  aliens  were  those  patients,  not  included  in  other 
classes,  that  had  been  in  this  State  less  than  2  months.  Applying  the  legal 
definition,  these  patients,  according  to  the  Poor  Law,  would  have  fallen 
into  the  class  of  State  Poor^  cases.  There  were  184  such  cases,  exclusive 
of  those  in  other  classes.  A  special  statement  will  be  found  on  pages  51  and 
52  regarding  the  patients  in  the  Hospital  in  this  year  who  had  been  less  than 
2  months  in  the  State  before  their  admission. 

The  proportion  of  these  1,426  non-resident  aliens,  exclusive  of  those 
in  other  classes,  who  had  not  lived  in  the  United  States  long  enough  to 
gain  a  settlement  was  large,  totaling  357.  The  entire  number  of  these 
non-resident  aliens  less  than  i  year  in  the  United  States  was  859,  60  per 
cent,  of  the  alien  non-residents,  or  35  per  cent,  of  all  non-residents  admit- 
ted in  this  year.  It  is  apparent,  therefore,  that  a  large  part  of  the  burden 
upon  the  City  through  the  Hospital  for  the  maintenance  and  care  of  non- 
residents comes  from  the  recently  landed  population. 

There  were  a  number  of  cases,  78  in  all,  of  patients  who  claimed  to 
have  lived  long  enough  in  New  York  State  to  have  gained  a  settlement, 
but  whb  had  not  established  a  settlement  in  the  City.  These  were  grouped 
under  the  division  of  "county  or  town  cases,"  -  and  further  subdivided  as 
"county  or  town  cases  with  New  York  City  address,"  29  patients;  "county 
or  town  cases  without  New  York  City  address."  29  patients ;  "county  or 
town  cases  giving  no  address,"  20  patients.  The  blank  spaces  on  the  his- 
tory cards,  designed  to  be  filled  in  with  information  that  would  clearly 
establish  the  legal  residence  of  these  patients,  were  apparently  never  used 
in  taking  the  history  in  the  admitting  office.  It  is  not  possible,  therefore, 
to  say  where  these  individuals  had  their  legal  settlement.  The  histories, 
however,  showed  a  residence  of  i  or  more  years,  and,  in  some  cases,  of 
a  lifetime  in  New  York  State. 

There  were  22  cases,  half  of  which  had  been  in  the  United  States  less 
than  I  month,  for  whose  expenses  a  steamship  company  was  apparently 
properly  liable,  under  the  regnlations  of  the  Bureau  of  Immigration  and 
Naturalization  of  the  United  States  Department  of  Labor.  Also  there  were 
42  aliens  who  had  not  been  in  the  State  of  New  York  for  the  period  of  I 
year  necessary  for  them  to  establish  a  residence  here.  In  the  case  of  73 
others,  on  account  of  the  incompleteness  of  the  records  of  the  Hospital,  it 
was  not  possible  to  ascertain  in  what  state  these  had  a  settlement.  A  few 
cases  among  these  aliens  gave  addresses  outside  of  the  State  of  New  York 
and  claimed  to  have  a  settlement  in  New  York  City.  There  were  8  such 
found  during  this  year.     (See  Table  X.) 

Non-Resident  Citizens 

The  non-resident  citizens,  as  shown  upon  the  admission  records  of  the 
institution,  were  not  so  numerous  during  this  year  as  the  non-resident 
aliens.    There  were,  however,  by  their  own  statements,  1,005.    But,  because 

'  The  Hospital  records  do  not  show  the  exact  number  of  days'  residence  in  the 
case  of  patients  in  the  State  over  i  month  and  less  than  2  months.  It  has,  there- 
fore, been  necessary  to  class  as  "State  Poor"  all  less  than  2  months  in  the  State. 
Subsequent  investigation  indicates  that  the  results  are  an  understatement  of  the 
actual  facts  rather  than  an  overstatement. 

"These  cases  as  referred  to  here  and  elsewhere  in  this  Report  are  not  neces- 
sarily county  or  town  poor.     See  (b)   Non-Residents  of  New  York  City,  page  33. 


ALIENS  AND   NON-RESIDENTS  1 29 

of  the  results  of  a  supplementary  investigation  made  in  a  small  propor- 
tion of  the  cases,  this  number  is  not  considered  to  reflect  accurately  the 
total  number  of  such  non-residents  admitted.  As  a  matter  of  fact,  in 
many  cases  where  supplementary  investigation  was  made,  the  admission 
statements  were  corrected,  and  it  was  found  that  there  was  a  decided 
tendency  on  the  part  of  the  patients  to  exaggerate  their  length  of  resi- 
dence, as  well  as  to  make  unwarranted  statements  regarding  their  citizen- 
ship. 

Accepting,  however,  these  uncorrected  statements  of  the  patients,  which 
show  that  there  were  1,005  non-resident  citizens  admitted  during  the  year, 
it  was  found  that  these  received  9,902  days  treatment,  at  an  estimated  cur- 
rent expense  to  the  City  of  $17,922.62.  Of  this  large  number  of  non-resi- 
dents payments  were  made  for  only  50,  which  amounted  to  $533.  (Table 
XL) 

Conspicuous  among  this  class  of  patients  were  those  cases  that  ap- 
parently were  removable  by  the  State  Board  of  Charities,  there  having 
been  240  during  the  year.  Many  of  these  had  been  in  the  City  only  a 
very  short  period  of  time;  23  were  admitted  to  the  Hospital  on  the  day 
they  came  to  the  City ;  36  others  had  been  less  than  3  days  in  the  City ;  14 
more  less  than  i  week;  71  others  less  than  2  months;  and  more  than  half 
of  the  remainder  less  than  6  months. 

Another  prominent  class  among  the  citizens  was  that  of  patients  who 
claimed  a  residence  of  a  considerable  period  of  time  in  the  State  of  New 
York,  which  in  some  cases  covered  the  entire  life,  but  who  had  not  estab- 
lished a  settlement  in  the  City  of  New  York.  These  aggregated  222  in  all, 
and  appear  in  the  same  table  as  "county  or  town  cases."  Of  these,  117 
gave  a  New  York  City  address,  which  would  indicate,  if  the  address  had 
been  their  actual  residence,  that  they  had  had  some  period  of  stay  within 
the  City.  However,  investigation  proved  that  not  infrequently  an  address 
given  in  such  a  case  was  not  the  residence  of  the  patient,  but  the  address 
'  of  some  relative  or  friend  within  the  City,  or  of  a  temporary  lodging 
house.  Among  those  who  gave  the  City  addresses  were  4  who  had  been 
in  the  City  less  than  i  day;  3  more  who  had  been  in  the  City  less  than  3 
days;  11  others  who  had  been  in  the  City  less  than  i  week;  26  more  who 
had  been  in  the  City  less  than  i  month.  Among  these  222  patients  that 
were  apparently  residents  of  other  counties  or  towns  were  92  who  did  not 
give  a  New  York  City  address.  Over  half  of  these  had  been  in  the  City 
less  than  3  days.  In  the  case  of  13  of  the  222  patients  no  residence  ad- 
dress whatever  was  given  of  the  patient,  but  the  history  cards  showed 
that  they  had  all  been  in  the  City  for  a  varying  length  of  time,  in  no  case, 
however,  over  6  months. 

Apart  from  such  patients  included  in  the  classes  already  mentioned 
and  in  other  classes  of  citizen  non-residents,  there  were  148  who  had  had  less 
than  2  months'  residence  in  the  State  of  New  York,  and  who  were,  under 
the  definition  of  the  State  Poor  Law,  State  Poor  cases.  More  than  one- 
half  of  these  cases  had  been  in  the  City  less  than  i  week  before  admission 
to  the  Hospital,  and  two-thirds  of  the  remainder  had  been  in  the  City  less 
than  a  month.  The  incompleteness  of  the  records  made  it  difficult  to  get 
an  accurate  idea  of  the  number  of  these  cases  within  the  institution.  For 
example,  there  were  cases  in  which  the  records  lacked  information  as  to 
whether  these  individuals  had  established  a  settlement  in  the  State  of  New 
York  or  not,  and  there  were  38  cases  of  patients  who  gave  residence  ad- 
dresses outside  of  New  York  State,  although  they  claimed  a  settlement 


130  HOSPITAL   COMMITTEE 

within  New  York  City.  This  seeming  discrepancy  remained  without  cor- 
rection or  confirmation  upon  the  records.  A  special  statement  on  the  State 
Poor  in  the  Hospital  in  1912  will  be  found  on  page  140. 

Of  the  1,005  admissions  of  non-resident  citizens,  69  were  patients  who 
had  lived  less  than  i  year  within  the  State  of  New  York  (in  addition 
to  such  included  in  other  classes).  Most  of  the  69  had  lived  less  than  6 
months  in  the  City,  including  a  few  who  had  only  a  few  days  residence 
in  the  City.  Another  class  of  cases  wherein  the  admission  records  possi- 
bly contradicted  themselves  included  22  patients  who  claimed  to  have  a  set- 
tlement within  New  York  City  but  gave  addresses  in  some  other  locality. 
There  were  also  among  these  1,005  admissions  a  class  that,  for  humani- 
tarian reasons  and  legal  provisions,  seemed  justifiable  as  patients  within 
the  Hospital,  even  though  they  had  not  established  a  settlement  within  the 
City.  These  amounted  in  all  to  80  during  the  year.  The  justification  for 
the  reception  of  50  of  these  within  the  Hospital  was  based  upon  the  fact 
that  they  paid  for  their  maintenance,  in  accordance  with  the  provisions  of 
the  Charter,  Title  11,  Section  692,  Par.  8,  as  follows : 

The  said  board  of  trustees  may  permit  the  reception  and  treatment  in  said 
hospitals  of  persons  who  do  not  reside  in  the  City  of  New  York,  provided  that 
every  person  so  receiving  treatment  shall  be  required  to  pay  such  sum  for  board 
and  attendance  as  may  be  fixed  by  said  board  of  trustees,  and  provided  that  no 
such  person  shall  be  received  to  the  exclusion  of  patients  who  reside  in  said 
City.     .    .     . 

The  quotation  of  this  section  from  the  Charter  is  not,  however,  to  be  con- 
sidered as  endorsement  of  the  ability  of  the  Hospital  to  furnish  accom- 
modation to  these  patients  without  overcrowding  and  thereby  hampering 
the  facilities  for  the  treatment  of  residents  of  the  City. 

Apparent  Contraction  of  Ailment  Before  or  After  Coming  to  New  York  City. 

It  is  of  interest  to  this  community  to  know  whether  the  dependents  it 
is  caring  for  in  municipal  hospitals  at  public  expense  had  the  ailments  which 
brought  about  this  dependence  before  they  came  to  the  City,  or  whether 
these  ailments  were  contracted  subsequently.  It  is  obviously  difficult  to 
reach  such  a  conclusion,  because  of  the  indefinite  character  of  hospital  diag- 
noses and  the  consequent  inability  to  determine  from  this  source  how  long 
the  ailments  have  been  in  progress.  However,  a  tabulation  was  made  of  the 
1,005  non-resident  citizens  who  were  admitted  to  Bellevue  Hospital  in  1912. 
This  tabulation  will  be  seen  in  Table  XXXVI. 

These  cases  were  assembled  into  3  classes  similar  to  those  in  Tables 
VII,  VIII,  and  IX;  namely,  Class  IV,  Citizens  whose  admissions  were 
authorized  by  Sec.  692,  Subd.  7,  of  the  City  Charter;  Class  V,  Citizens 
whose  admissions  were  not  authorized  by  this  same  section ;  Class  VI,  Citi- 
zens for  whose  admissions  the  authorization  by  this  section  was  not  evi- 
dent. Under  each  one  of  these  classes,  and  also  under  the  combined  total 
of  the  three,  the  cases  were  divided  according  to  the  probable  contraction 
of  the  ailments  of  the  patients,  before  and  after  they  came  to  New  York 
City,  with  an  indefinite  subdivision  for  those  cases  in  which  it  was  im- 
possible to  determine  from  the  diagnoses  how  long  the  patients  had  been 
suffering  from  their  ailments.  The  division  between  the  cases  of  ailments 
contracted  before  coming  to  the  City  and  those  from  ailments  con- 
tracted after,  was  made  on  the  basis  of  the  incubation  or  duration  of 


ALIENS  AND  NON-RESIDENTS  131 

the  particular  ailment  that  must  have  preceded  its  detection  as  a  case 
needing  hospital  treatment.  In  a  large  number  of  cases,  which  in  fact 
totaled  slightly  over  one-half  of  the  non-resident  citizens,  there  was  no 
basis  for  determining  the  duration  of  the  disease,  consequently  these  536 
cases  had  to  be  placed  in  the  indefinite  class.  Of  this  indefinite  class,  213 
were  cases  of  alcoholism.  It  is  apparent  that  it  is  impossible  to  say  how 
long  these  patients  had  been  addicted  to  the  use  of  alcohol  without  full  clini- 
cal information  on  this  point,  but  it  was  interesting  to  notice  that  in  the  case 
of  over  one-third  of  these  213  alcoholic  admissions  the  patients  had  been 
less  than  24  hours  in  the  City  of  New  York.  The  general  class  of  "Causes 
not  otherwise  specified,"  which  consisted  of  85  cases,  was  also  of  cases 
found  to  be  indefinite;  and  the  traumatisms,  burns,  and  other  cases  that 
could  have  arisen  from  accidents,  and  which  represented  a  total  of  75  cases, 
were  also  included  in  the  indefinite  cases.  Over  one-third  of  the  patients 
represented  by  the  diagnoses  classified  as  "Causes  not  otherwise  specified," 
and  over  one-half  of  those  represented  by  the  diagnoses  "Traumatism, 
bums,  etc.,"  had  been  in  the  City  less  than  24  hours  prior  to  their  admis- 
sion to  the  Hospital.  The  next  largest  class  included  among  these  indefi- 
nite cases  was  the  insane,  or  alleged  insane,  who  totaled  73  admissions, 
over  one-half  of  whom  were  patients  who  had  been  in  the  City  less  than 
24  hours.  The  three  remaining  groups  of  these  indefinite  cases  were  the 
diseases  of  the  digestive  system  not  specified  as  chronic,  which  numbered 
56  cases ;  the  18  cases  of  hernia ;  and  the  16  pregnancy  cases  discharged  be- 
fore confinement.  Among  these  three  last  named  groups  there  were  15 
cases  of  patients  in  the  City  less  than  24  hours. 

Of  the  469  cases  that  it  seemed  could  be  safely  divided  according  to  the 
contraction  of  the  ailment  before  or  after  coming  to  the  city,  315,  or  over 
two-thirds  of  the  total,  appeared  to  have  had  the  ailment  before  coming 
to  New  York  City.  The  majority  of  these  cases  were  found  to  fall  among 
the  tubercular,  cardiac,  chronic  alcoholic,  drug  habit,  and  venereal  dis- 
eases. Of  these  315  cases,  205,  or  65  per  cent.,  will  be  seen  by  reference  to 
Table  XXXVI  to  have  been  in  Class  V,  and  therefore  had  not  been  brought 
from  the  street  or  any  public  place. 

Many  of  the  ailments  included  in  this  tabulation  as  having  possibly  been 
contracted  after  the  patients  came  to  New  York  City  probably  were  in 
progress  before  this  time,  the  division  having  been  made  on  the  generous 
allowance  that  the  ailments  had  been  contracted  at  the  most  recent  possible 
date.  Also,  where  the  hospital  diagnosis  did  not  specify  whether  an  ailment 
was  acute  or  chronic,  it  was  classed  as  acute. 

Diagnoses  of  Non-Residents'  Cases 

The  diagnoses  of  these  2,431  non-residents  admitted  to  Bellevue  Hos- 
pital in  1912  are  significant,  as  they,  to  some  extent,  indicate  whether  these 
non-residents  were  suffering  from  emergent  or  chronic  conditions,  and 
whether  these  conditions  were  of  recent  or  more  remote  origin  at  the  time 
of  their  admission. 

The  discharge  diagnoses  for  these  patients  as  they  were  entered  upon 
the  records  of  Bellevue  Hospital  are  shown  in  Table  XXXVII.  In  this 
table  it  will  be  seen  that  22  per  cent,  of  the  citizen  non-residents  were  admit- 
ted to  the  Hospital  on  account  of  alcoholism  and  drug  habit,  and  8  per  cent. 
ef  the  aliens  received  treatment  for  the  same  trouble. 

Insane  cases  formed  a  considerable  proportion  ,of  the  aliens,  having 


132  HOSPITAL   COMMITTEE 

amounted  to  184  cases,  or  12.9  per  cent,  of  the  total  admitted,  while  the 
insane  formed  7.3  per  cent,  of  the  citizens,  having  amounted  to  73  cases. 

Tuberculosis  of  the  lungs  was  a  prominent  diagnosis,  having  been  the 
ailment  from  which  121,  or  8.5  per  cent.,  of  the  total  aliens  were  suffering, 
and  59  cases,  or  5.9  per  cent.,  of  the  total  citizens.  Taking  pulmonary 
tuberculosis  and  other  tubercular  diseases  together,  201  cases  of  aliens  and 
citizens  were  afflicted  with  tuberculosis.  Of  this  number,  over  two-thirds, 
or  133,  were  aliens. 

In  the  venereal  and  genito-urinary  cases,  however,  the  citizens  formed 
the  larger  proportion,  there  having  been  40  cases  of  gonorrhea ;  36  cases  of 
syphilis ;  23  cases  of  chronic  genito-urinary  conditions,  or  a  total  of  99 
cases  among  the  citizens,  which  formed  9.9  per  cent,  of  the  admissions  of 
non-resident  citizens,  as  compared  with  the  5  cases  of  gonorrhea ;  39  cases 
of  syphilis;  8  cases  of  chronic  genito-urinary  ailments,  or  52  cases  in  all 
among  the  aliens,  which  formed  3.8  per  cent,  of  the  total  admissions  of 
aliens.  This  made  a  total  of  151  cases  of  aliens  and  citizens  who  had 
venereal  or  chronic  genito-urinary  conditions. 

There  were  30  cases  of  epilepsy  and  other  diseases  of  the  nervous  sys- 
tem among  the  aliens,  as  compared  with  24  of  the  citizens.  There  were  20 
cases  of  hernia  among  the  aliens,  and  18  among  the  citizens. 

In  considering  the  chronic  cases  not  already  mentioned  it  will  be  seen 
that  there  were  among  the  aliens  19  cases  of  chronic  alcoholism;  6  cases  of 
chronic  rheumatism;  9  cases  of  chronic  diseases  of  the  respiratory  system; 
24  cases  of  chronic  diseases  of  the  heart  and  circulatory  system;  and  5  of 
chronic  diseases  of  the  digestive  system,  as  compared  with  24  cases  of 
chronic  alcoholism;  5  cases  of  chronic  rheumatism;  i  case  of  chronic  dis- 
ease of  the  respiratory  system;  58  cases  of  chronic  diseases  of  the  heart 
and  circulatory  system;  and  13  cases  of  chronic  diseases  of  the  digestive 
system  among  the  citizens.  These  chronic  ailments  formed  a  total  of  lOl 
cases,  or  9.8  per  cent,  of  all  the  citizens,  and  63  cases,  or  4.4  per  cent,  of 
the  total  admissions  of  aliens. 

There  were  more  cases  of  cancers  and  tumors  among  the  aliens  than 
among  the  citizens,  these  having  been  13  and  5,  respectively.  Typhoid  fever 
claimed  7  cases  among  the  aliens,  as  compared  with  i  case  among  the  citi- 
zens. Other  epidemic  diseases  were  represented  in  13  cases  among  the  citi- 
zens, and  none  among  the  aliens.  Malaria  claimed  20  aliens  and  15  citi- 
zens ;  and  the  parturition  and  pregnancy  cases  amounted  to  61  among  the 
aliens,  and  48  among  the  citizens.  The  non-residents  admitted  for  erysipe- 
las and  cellulitis  were  entirely  among  the  aliens,  and  formed  a  total  of  87 
cases,  or  6  per  cent,  of  their  total  admissions. 

In  the  acute  diseases,  in  which  are  classed  all  diseases  not  shown  on  the 
records  to  be  chronic,  the  aliens  were  more  heavily  represented  than 
the  citizens.  There  were  46  cases  of  rheumatism,  as  compared  with  12 
among  the  citizens;  yj  cases  of  acute  diseases  of  the  male  genital  organs, 
as  compared  with  24  among  the  citizens ;  18  cases  of  female  genital  organs, 
as  compared  with  9  among  the  citizens.  The  acute  diseases  of  the  nervous 
system,  however,  formed  only  2  cases  among  the  aliens,  as  compared  with 
15  among  the  citizens.  There  were  69  cases  of  acute  diseases  of  the  respira- 
tory system  among  the  aliens,  as  compared  with  22  among  the  citizens,  and 
the  9  cases  of  aliens  admitted  for  acute  diseases  of  the  heart  and  circulatory 
system  were  equaled  by  those  of  citizens.  The  cases  admitted  for  acute 
diseases  of  the  digestive  system  numbered  loi  aliens  and  76  citizens. 

Under   "Causes    not   elsewhere    specified,"    which    were   miscellaneous 


ALIENS  AND   NON-RESIDENTS  133 

cases,  there  were  154  cases  of  aliens  and  85  cases  of  citizens,  while  the 
accident  cases  classed  as  "Traumatism,  burns,  etc.,"  embraced  163  cases  of 
aliens  and  75  cases  of  citizens. 

Illustrative  Cases 

Extracts  from  a  few  histories  of  the  aliens,  non-residents,  and  State  Poor 
are  given  here,  under  the  same  classes  and  subdivisions  employed  in  the 
tables  already  referred  to.     (Tables  IV  to  XXXIII.) 

Class  I-i.     Apparently  Improperly  Admitted  to  the  United  States. 

A  native  of  Portugal.  Age  32  years.  Single.  Occupation,  sailor.  This  patient 
was  in  the  employ  of  a  steamship  company  and  had  been  in  the  United  States 
only  2  days.  He  was  brought  to  the  Hospital  by  the  Bellevue  ambulance,  with  a 
venereal  disease  impossible  to  have  originated  since  his  admission  to  this  country. 
He  remained  in  the  Hospital  4  days  as  a  free  patient. 

A  native  of  Canada.  Age  35  years.  Single.  Occupation,  domestic.  This 
patient  had  been  in  the  United  States  only  6  weeks  when  she  was  brought  to  the 
Hospital  by  the  Bellevue  ambulance.  She  had  chronic  pulmonary  tuberculosis,  un- 
likely to  have  originated  since  her  admission  to  the  United  States.  She  was  in 
the  Hospital  4  days,  and  was  discharged,  not  removed  for  deportation. 

Class  I-3.    Apparently  Removable  by  State  Board  of  Charities. 

This  patient  was  a  native  of  Italy,  who  had  been  in  the  United  States  14  months, 
and  in  New  York  only  2  days.  He  was  brought  to  the  Hospital  by  an  ambulance 
not  belonging  to  Bellevue,  with  pulmonary  tuberculosis.  He  remained  in  the  Hos- 
pital S  days  as  a  free  patient  and  was  transferred  from  there  to  another  City 
hospital. 

A  native  of  Italy.  Married.  Occupation,  shoemaker.  This  patient  had  been 
in  the  country  7  months,  and  in  New  York  City  only  4  days.  He  was  brought 
to  the  Hospital  by  the  Bellevue  ambulance  from  a  private  residence.  He  remained 
in  the  Hospital  7  days  as  a  free  patient  and  was  then  transferred  to  another  City 
hospital,   with   a  diagnosis   of   chronic  pulmonary   tuberculosis. 

Class  I-4.     Apparently   Removable  by   State  Board  of  Alienists. 

A  native  of  Russia.  Age  25  years.  Single.  No  occupation.  This  patient  had 
been  in  the  United  States  only  10  months  when  he  was  brought  to  the  Hospital  by 
the  Bellevue  ambulance.  He  had  delusions  of  persecution  and  had  been  threatening 
to  kill  every  one,  according  to  his  admission  history.  He  had  refused  to  work,  con- 
tinually claiming  to  be  sick.  He  remained  in  the  Hospital  for  4  days  as  a  free 
patient  and  was  then  discharged  in  charge  of   relatives. 

A  native  of  West  Indies.  Age  19  years.  Colored.  Single.  Occupation,  ser- 
vant. This  patient  had  been  in  the  United  States  10  months  and  in  New  York  City 
only  2  months  when  she  came  to  the  Hospital.  She  remained  in  the  Hospital  3 
days  as  a  free  patient  and  was  then  transferred  to  a  State  hospital  for  insane. 

Qass  I-s.    Apparently  County  or  Town  Case. 

A  native  of  Ireland.  Age  30  years.  Single.  Occupation,  orderly.  This  pa- 
tient claimed  10  years  residence  in  New  York  State  but  only  i  day  in  New  York 
City  when  brought  to  the  Hospital  by  an  ambulance  not  belonging  to  Bellevue. 
He  had  sciatica  and  remained  in  the  Hospital  11  days  as  a  free  patient.  He  was 
then  transferred  to  another  City  hospital. 

Qass  II-i   and   2.     Apparently   Improperly  Admitted  to  the  United   States   and 
Deportable  by  the  United   States. 

A  native  of  Russia.  Age  26  years.  This  patient  had  been  in  the  United 
States  only  8  days  when  admitted  to  Bellevue  Hospital.  He  had  chronic  pulmonary 
tuberculosis,  impossible  to  have  originated  since  his  admission  to  this  country.    He 


134  HOSPITAL  COMMITTEE 

was  in  the  Hospital  ii  days  as  a  free  patient  and  was  then  transferred  to  another 
City  hospital. 

A  native  of  France.  Age  30  years.  Married.  Occupation,  waiter.  This  patient 
had  been  in  the  United  States  sl/i  months  and  in  New  York  City  for  i  month 
when  admitted  to  Bellevue  Hospital.  He  died  of  pulmonary  tuberculosis  after 
10  days  in  the  Hospital  as  a  free  patient 

Class  n-3.     Apparently  Removable  by   State  Board  of   Charities. 

A  native  of  Turkey.  Age  22  years.  Single.  Occupation,  diamond  cutter.  This 
patient  had  been  in  the  United  States  only  4  months  when  admitted.  He  was  in  the 
Hospital  7  days  as  a  free  patient,  with  chronic  articular  rheumatism,  and  also  a 
venereal  disease.     He  was  then  discharged  and  not  removed  for  deportation. 

A  native  of  Finland.  Age  35  years.  Single.  This  patient  had  been  in  the 
United  States  3  months  when  admitted  to  Bellevue  Hospital.  He  was  in  the 
Hospital  6  days  as  a  free  patient,  with  chronic  alcoholism  and  delirium  tremens.  He 
was  discharged  and  not  removed  for  deportation. 

Class  n-4.     Apparently  Removable  by  State  Board  of   Alienists. 

A  native  of  Poland.  Age  25  years.  Occupation,  laborer.  This  patient  had  been 
in  the  United  States  only  6  months  when  brought  to  the  Hospital  by  an  ambulance 
not  belonging  to  Bellevue.  He  was  insane  and  had  erysipelas,  and  after  74  days 
in  Bellevue  as  a  free  patient  he  was  transferred  to  a  State  hospital  for  insane. 

A  native  of  Ireland.  Age  22  years.  Single.  No  occupation.  This  patient  had 
been  in  the  United  States  only  2  months  when  admitted  to  Bellevue  Hospital. 
He  was  in  the  Hospital  9  days  as  a  free  patient.  He  was  transferred  as  insane 
to  a  State  hospital  for  insane. 

Class  II-5.    Apparently   County  or   Town   Cases.' 

A  native  of  Hungary.  Age  42  years.  Married.  Occupation,  cooper.  This 
patient  had  been  in  New  York  State  i  year  but  in  New  York  City  only  8  days 
when  admitted  to  Bellevue  Hospital.  He  had  pneumonia  and  simple  anemia,  and 
remained  in  the  Hospital  29  days  as  a  free  patient. 

A  native  of  Greece.  Age  22  years.  Single.  Occupation,  waiter.  When  admitted 
to  Bellevue  Hospital  this  patient  had  been  in  the  United  States  and  in  New  York 
State  2  years,  and  in  New  York  City  only  2  days.  He  had  an  inguinal  hernia 
and  was  in  the  Hospital  17  days  as  a  free  patient. 

Class   II-7.    Apparently   Charges   of    Steamship   Company. 

A  native  of  England.  Age  36  years.  Occupation,  steward  on  a  steamship.  This 
patient  had  been  in  New  York  City  only  2  weeks  when  brought  to  the  Hospital 
by  an  ambulance  not  belonging  to  Bellevue.  He  had  chronic  pulmonary  tuberculosis 
and  died  after  4  days  in  the  Hospital  as  a  free  patient. 

Class  IV-3.    Apparently  Removable  by  State  Board  of  Charities. 

A  native  of  the  United  States.  Age  20  years.  Occupation,  laborer.  This  patient 
had  been  in  the  State  of  New  York  only  2  weeks  when  brought  to  the  Hospital 
by  an  ambulance  not  belonging  to  Bellevue.  He  had  morphine  poisoning  and  re- 
mained in  the  Hospital  13  days  as  a  free  patient.  His  own  address  and  those 
given  for  relatives  were  all  outside  the  State.  He  was  discharged  and  not  removed 
by  the  State  Board  of  Charities. 

A  native  of  the  United  States,  who  gave  an  address  outside  New  York  State. 
He  was  brought  to  the  Hospital  by  an  ambulance  and  remained  there  5  days  as  a 
free  patient.  He  was  not  removed  by  the  State  Board  of  Charities,  and  was  dis- 
charged with  a  diagnosis  of  arteriosclerosis  and  chronic  nephritis. 

CTass  IV-4.     Apparently  Removable  by  State  Board  of  Alienists. 

A  native  of  the  United  States.  Age  31  years.  Married.  This  patient  gave  an 
address   outside  New  York  State,  and  had  been  in  New  York  City  only  3  days 

'See  footnote  2  on  page  40. 


ALIENS  AND   NON-RESIDENTS  135 

when  admitted  to  Bellevue.    He  was  in  the  Hospital  S  days  as  a  free  patient  and 
was  then  transferred  to  a  State  hospital  for  insane. 

A  native  of  the  United  States.  Age  35  years.  Widower.  Occupation,  ma- 
chinist. When  admitted  to  Bellevue  this  patient  had  been  in  New  York  State 
only  I  day.  He  was  in  the  Hospital  4  days  as  a  free  patient  and  was  then  trans- 
ferred to  a  State  hospital  for  insane. 

Class  IV-S.    Apparently  County  or  Town  Cases. 

A  native  of  the  United  States.  Age  21  years.  Single.  This  patient  had  been 
all  his  life  in  New  York  State  but  only  4  months  in  New  York  City  when  admitted 
to  Bellevue.  He  came  to  the  Hospital  with  a  diagnosis  of  chronic  nephritis  and 
acute  mania,  and  remained  there  5  days  as  a  free  patient. 

Qass  V-3.    Apparently  Removable  by  State  Board  of  Charities. 

A  native  of  the  United  States.  Age  35  years.  Single.  Occupation,  driver. 
This  patient  had  been  only  4  months  in  New  York  State  when  admitted  to  the 
Hospital.  He  had  chronic  pulmonary  tuberculosis.  After  4  days  in  Bellevue  as  a 
free  patient  he  was  transferred  to  another  City  hospital.  The  address  given  for 
relatives  was  outside  New  York  State. 

A  native  of  the  United  States.  Age  33  years.  Occupation,  stenographer.  This 
patient  had  been  in  New  York  State  8  months  when  admitted  to  Bellevue.  He 
remained  2  days  in  the  Hospital  as  a  free  patient  and  was  then  discharged,  with  a 
diagnosis  of  chronic  morphine  poisoning  and  multiple  abscesses.  He  was  not  re- 
moved by  the  State  Board  of  Charities. 

Class  V-4.     Apparently  Removable  by  State  Board  of  Alienists. 

A  native  of  the  United  States.  Age  38  years.  Single.  Occupation,  cook. 
This  patient  had  been  in  New  York  State  only  i  week  when  admitted  to  Bellevue. 
He  remained  in  the  Hospital  21  days  as  a  free  patient  and  was  then  transferred 
to  a  State  hospital  for  insane. 

A  native  of  the  United  States.  Age  38  years.  Married.  This  patient  had 
been  in  New  York  State  2  months  when  admitted  to  Bellevue.  She  remained  in  the 
Hospital  12  days  as  a  free  patient  and  was  then  transferred  to  a  State  hospital 
for  insane. 

Qass  V-5.    Apparently  County  or  Town  Cases. 

A  native  of  the  United  States.  Age  25  years.  Single.  Occupation,  printer. 
This  patient  had  been  in  New  York  City  only  4  days  when  admitted  to  Bellevue. 
He  remained  in  the  Hospital  2  days  as  a  free  patient  and  was  then  discharged,  with 
a  diagnosis  of  cocaine  poisoning.  The  address  given  for  relatives  was  outside 
New  York  State. 

A  native  of  the  United  States.  Single.  Occupation,  laborer.  This  patient  had 
been  in  New  York  City  only  i  day  and  claimed  life-time  residence  in  New  York 
State  when  admitted  to  Bellevue.  He  had  a  cyst  infection  and  remained  in  the 
Hospital  6  days  as  a  free  patient. 

Means  of  Relief 

(a)  Removal  by  the  United  States  Immigration  Service 

The  different  agencies  of  relief  of  charitable  institutions  from  the  bur- 
den of  alien  and  non-resident  dependents  have  already  been  discussed  in 
this  report  (pages  117  to  120).  The  operation  of  these  agencies  in  Belle- 
vue Hospital  was  made  an  object  of  study.  Prior  to  the  last  2  or  3  years 
there  seemed  to  have  been  only  an  occasional  removal  from  the  Hospital 
of  aliens  improperly  within  the  country.  The  awakened  interest  of  the 
Board  of  Trustees  in  the  last  few  years,  however,  has  resulted  in  increased 
activity  in  this  direction. 

The  ordinary  process  for  the  removal  of  these  aliens  has  been  as  follows : 


136  HOSPITAL   COMMITTEE 

The  Department  of  State  and  Alien  Poor  of  the  State  Board  of  Chari- 
ties is  notilied  of  the  presence  of  deportable  aliens  in  the  Hospital  as  pa- 
tients ;  an  inspector  is  then  sent  out  from  the  office  of  this  Department 
of  the  State  Board  to  examine  such  of  this  class  of  patients  as  he  may  be 
able.  This  visit  of  the  inspector  may  be  either  preceded  or  followed  by  a 
request  upon  the  authorities  of  the  Hospital  from  the  branch  office  in  New 
York  City  of  this  Department  or  from  the  head  office  in  Albany,  that  this 
alleged  alien  be  detained  by  these  authorities  pending  investigation  into  the 
propriety  of  his  removal.  In  cases  where  the  information  supplied  to  the 
State  Board  seems  to  indicate  strongly  that  these  aliens  should  be  deported, 
this  "holding  notice"  not  uncommonly  precedes  the  inspector's  visit.  The  re- 
port of  the  inspector  is  then  made  to  the  Deputy  Superintendent  of  the  De- 
partment of  State  and  Alien  Poor  in  New  York  City,  and,  if  in  his  opinion 
the  facts  justify  such  action,  this  report  is  forwarded  to  Albany  to  the  Su- 
perintendent of  the  Department,  without  whose  approval,  it  is  understood,  no 
deportations  are  made.  If  the  information  given  to  the  Superintendent  seems 
to  him  to  justify  such  a  course,  he  may  seek  to  confirm  the  time  of  landing 
of  such  an  alien  by  a  letter  of  inquiry  to  the  Commissioner  of  Immigra- 
tion at  Ellis  Island.  On  account  of  the  possible  discrepancies  in  name,  and 
other  confusing  factors,  the  landing  may  not  be  confirmed  on  first  inquiry. 
Should,  however,  this  landing  be  confirmed,  and  the  case  be  turned  over 
to  the  United  States  Government  for  deportation  in  conformity  with  the 
provisions  of  the  law  quoted  on  page  117,  a  United  States  Immigration 
Inspector  may  be  sent  out  from  Ellis  Island  to  see  the  alleged  alien  and 
confirm  the  facts  submitted  as  grounds  for  his  removal.  When  the  authori- 
ties at  Ellis  Island  are  satisfied  that  an  alien  falls  within  the  provisions  of 
the  law  authorizing  removal,  a  statement  of  the  case  is  forwarded  to  the 
Department  of  Labor  in  Washington,  from  which  place,  upon  the  ap- 
proval of  the  authorities  there,  a  warrant  may  be  issued  for  the  arrest 
of  such  an  alien,  that  he  may  be  returned  to  the  country  from  which 
he  came.  It  is  quite  apparent  that  this  process  is  exposed  to  considerable 
delay.  The  State  Board  of  Charities  may  shorten  the  process  by  making 
the  removal  of  these  aliens  through  their  own  agents,  provided  the  Board 
has  sufficient  funds  for  that  purpose,  instead  of  referring  the  matter  to 
Ellis  Island. 

In  the  year  1912,  181  aliens  were  admitted  to  Bellevue  Hospital  who 
appeared  by  the  records  to  have  been  either  improperly  admitted  to  the 
United  States  or  to  have  been  deportable  by  the  Federal  Government 
(Table  XIII).  This  number  is  not  considered  to  be  more  than  suggestive, 
because  it  was  possible,  on  account  of  omissions  in  the  histories  from  which 
this  information  was  gathered,  to  include  in  this  class  only  those  recent 
arrivals  in  the  United  States  who  had  ailments  of  such  a  character  that  it 
seemed  impossible  that  they  had  been  contracted  since  landing  in  this 
country. 

It  is  more  than  probable  that,  of  the  273  aliens  who  had  been  in  New 
York  City  less  than  i  year  that  were  apparently  removable  by  the  State 
Board  of  Charities  (Table  X),  and  of  the  513  aliens  apparently  subject  to 
removal  by  the  same  Board  that  had  been  in  the  United  States  more  than  i 
year  and  less  than  3  years  (Table  XII),  there  was  a  large  proportion  of  per- 
sons, who,  if  their  histories  could  be  traced  out,  would  be  found  to  have 
had  some  physical  disability  or  disqualification  at  the  time  of  their  admis- 
sion to  this  country  which  would  have  justified  their  being  refused  admis- 


ALIENS  AND  NON-RESIDENTS  137 

The  same  might  be  said  of  the  mentally  unbalanced,  apparently  re- 
movable by  the  State  Board  of  Alienists,  of  whom  there  were  i6o  who 
had  lived  in  the  City  for  less  than  i  year,  and  100  who  had  been  in  this 
country  more  than  i  year  and  less  than  3  years.     (Tables  X  and  XII.) 

In  the  case  of  those  aliens  for  whose  arrest  a  warrant  is  issued  by  the 
Secretary  of  Labor,  payment  for  maintenance  is  supposed  to  be  made  by 
the  Government,  from  funds  available  for  that  purpose.  When,  however, 
the  process  of  removal  of  these  cases,  which  has  been  described,  is  taken 
into  consideration,  and  also  the  fact  that  the  Government  makes  no  pay- 
ment for  the  time  the  alien  has  been  in  the  Hospital  prior  to  the  date 
of  the  issuance  of  the  warrant,  it  is  evident  that  even  in  those  cases  for 
which  payment  is  made  the  remuneration  by  no  means  meets  the  expense 
to  the  City.  Reference  to  Tables  X  and  XIII  shows  that  the  expense  to 
the  City  of  181  cases  that  were  either  removed  by  the  United  States  officials, 
or  apparently  should  have  been  removed  by  them  in  1912,  was  $5,020.94, 
merely  for  the  current  expenses  at  the  institution.  The  total  receipts 
from  all  sources  for  these  patients  during  this  year  was  only  $187.50. 
While  it  is  possible  that  the  Government  might  not  feel  the  necessity  of  the 
deportation  of  a  few  of  these  cases,  it  is  evident  that  this  discrepancy  is  too 
large  to  be  disregarded. 

The  records  of  the  Hospital  do  not  show  that  more  than  8  of  these 
cases  were  removed,  and  the  monthly  reports  of  the  State  Board  of  Chari- 
ties show  only  5  removals  from  this  institution  by  United  States  officials 
during  the  entire  year  of  1912.  When  this  is  compared  with  the  statements 
made  in  the  Annual  Reports  of  the  Department  of  Public  Charities  for  the 
years  1902,  1903,  1904,  and  1905,  of  the  aliens  returned  by  this  Department 
to  the  Commissioners  of  Immigration,  it  will  be  seen  that  there  must  have 
been  a  much  more  effective  cooperation  between  the  Department  of  Charities 
and  the  immigration  authorities  in  those  years  than  now  exists  between  the 
Board  of  Trustees  of  Bellevue  Hospital  and  the  same  authorities.  The  fig- 
ures in  these  Annual  Reports  show  that  in  the  year  1902,  1,137  aliens  were 
returned  to  the  Commissioner  of  Immigration;  in  1903  there  were  861; 
in  1904,  328;  and  in  1905,  43.     (Table  II.) 

After  the  year  1905  these  Reports  contained  no  record  of  the  return  of 
any  aliens  by  the  Department  of  Public  Charities  to  the  Commissioners  of 
Immigration.  On  January  15,  1906,  a  general  order  was  issued  by  the  Com- 
missioner of  Public  Charities,  Robert  W.  Hebberd,  by  which  the  heads  of 
the  institutions  of  the  Department  were  instructed  to  report  all  State,  alien, 
and  non-resident  poor  to  the  Department  of  State  and  Alien  Poor  of  the 
State  Board  of  Charities.  It  is  upon  this  Department  of  State  and  Alien 
Poor  of  the  State  Board  that  Bellevue  Hospital  is  depending  to-day  for  the 
removal  of  aliens  who  are  likely  to  become  prolonged  or  chronic  depend- 
ents. 

(&)  Removal  by  the  State  Board  of  Charities 

Of  the  2,431  admissions  of  non-residents  of  New  York  City  to  Belle- 
vue in  1912,  the  records  for  2,011  gave  indications  as  to  the  length  of  their 
residence  in  New  York  State,  and  420  lacked  such  information  (Table 
XXXIV).  Of  these  2,011  cases,  1,707,  or  85  per  cent.,  appeared  from  the 
records  not  to  have  been  legal  residents  of  New  York  State,  while  304,  or 
15  per  cent,  had  been  in  the  State  i  year  and  over.  If  we  extend  the  pro- 
portion of  those  in  the  2,011  classified  cases  who  had  been  in  the  State  less 


138  HOSPITAL   COMMITTEE 

than  a  year  to  the  420  that  could  not  be  classified,  there  would  have  been 
2,064  admissions  in  Bellevue  Hospital  during  the  year  1912  classed  as  non- 
residents of  the  State. 

Of  the  1,707  admissions  of  apparent  non-residents  of  the  State,  1,178, 
or  69  per  cent,  of  the  total  number  classified,  were  aliens,  while  529,  or  31 
per  cent,  were  citizen  non-residents  of  the  State.  Of  the  aliens  classified 
for  residence,  however,  93.8  per  cent,  had  been  in  the  State  less  than  i  year, 
and  of  the  citizens  70.1  per  cent.  Extending  these  proportions  to  the  170 
cases  of  aliens  whose  time  in  the  State  was  not  indicated,  and  the  250  cases 
of  citizens,  there  would  have  been  1,288  admissions  classed  as  alien  non- 
residents of  New  York  State,  and  550  admissions  classed  as  citizen  non- 
residents in  Bellevue  Hospital  in  1912. 

Of  the  alien  non-residents  of  the  State,  773,  or  65.6  per  cent.,  were  not 
emergent  ambulance  or  alleged  insane  cases  admitted  to  the  Hospital.  There 
were  also  319  admissions  of  citizens,  or  60.3  per  cent.,  who  were  not  resi- 
dents of  the  State  and  who  were  not  emergent  or  psychopathic  cases. 
(Tables  V,  VHI,  and  XXXIV.) 

The  total  expense  of  alien  patients  admitted  whom  the  records  indicated 
were  non-residents  of  the  State,  plus  a  similar  proportion  of  those  whose 
residence  was  not  indicated  by  the  records,  was  $27,235.30.  The  expense  of 
the  Hospital  care  of  all  citizen  non-residents  for  the  year  was  estimated  to 
be  $9,688.40,  making  the  total  expense  of  the  estimated  number  of  alien 
and  citizen  non-residents  admitted  $36,923.70. 

In  defrayment  of  the  expenses  of  these  patients,  there  was  paid  to  the 
Hospital  the  sums  of  $288  for  aliens  and  $182  for  citizens,  making  a  total 
of  $470  received. 

The  total  removals  of  non-residents  of  the  City  in  this  year  was  122, 
according  to  the  Bellevue  records,  and  105  of  these  were  discharged  to  the 
State  Board  of  Charities;  11  to  the  Federal  Government;  and  6  to  the  State 
Board  of  Alienists  (Table  XXXIII).  Thus,  it  will  be  seen  that  the  total 
of  these  non-resident  removals  by  the  State  Board  of  Charities  constituted 
an  inconsiderable  proportion  of  the  total  number  of  admissions.  Also,  less 
than  15  per  cent,  of  those  whom  the  records  appeared  to  indicate  might  prop- 
erly have  been  removed  by  the  United  States  Government  or  by  the  State 
Board  of  Charities  were  taken  from  the  institution. 

Of  the  1,308  admissions  of  aliens  who  had  been  in  the  United  States 
more  than  i  year  and  less  than  3  years,  there  were  3  cases  apparently  de- 
portable by  the  United  States  Government  (Table  XII)  which  were  re- 
moved by  the  United  States  Immigration  Service;  and  of  513  of  these  cases 
apparently  removable  by  the  State  Board  of  Charities,  36  were  removed  by 
this  agency,  according  to  the  Hospital  records.  Also,  there  were  100  cases, 
apparently  proper  subjects  for  removal  by  the  State  Board  of  Alienists, 
whose  removals  are  usually  efifected  after  commitment  to  State  hospitals. 
According  to  the  monthly  reports  of  removals  by  the  State  Board  of  Chari- 
ties, the  State  Board  of  Charities  removed  only  7  per  cent,  of  the  aliens 
more  than  i  year  and  less  than  3  years  in  the  United  States  that  the  records 
indicated  might  have  been  removed. 

Of  the  total  of  2,431  non-residents,  60  per  cent,  were  allowed  to  leave 
the  institution  by  ordinary  discharge.  Many  cases  that  were  referred  to  the 
Department  of  State  and  Alien  Poor  for  investigation  and  possible  removal 
were  discharged  or  transferred  from  this  institution  without  having  been 
investigated  by  the  inspectors  of  this  Department. 

For  example,  in  the  month  of  April,  191 1,  out  of  a  total  of  354  cases  in 


ALIENS  AND  NON-RESIDENTS  139 

the  hands  of  the  Department  of  State  and  Alien  Poor  of  the  State  Board 
of  Charities  which  had  been  referred  to  them  from  Bellevue,  52  were  re- 
moved from  Bellevue  or  institutions  to  which  they  had  been  transferred 
from  Bellevue,  while  172  had  been  allowed  to  leave  Bellevue  Hospital 
without  being  subjected  to  any  examination  on  the  part  of  the  inspectors  of 
the  Department  of  State  and  Alien  Poor,  and  on  May  i,  191 1,  there  were 
130  cases  pending  in  the  hands  of  the  same  Department.  In  May,  191 1, 
from  a  total  of  388  cases,  there  were  21  removals  from  Bellevue  and  other 
institutions  of  patients  reported  for  investigation,  while  179  of  this  number 
had  not  been  examined. 

(c)  Removal  by  the  State  Board  of  Alienists 

A  few  cases,  6  in  all,  of  which  2  were  of  aliens  and  4  were  of  citizens, 
were  removed  from  Bellevue  Hospital  during  the  year  by  the  State  Board  of 
Alienists,  according  to  the  general  records  of  the  Hospital.  This  Board  has 
been  actively  at  work  relieving  the  State  of  the  maintenance  of  aliens  in 
the  State  hospitals  for  the  insane.  There  were  201  cases  in  Bellevue  Hos- 
pital in  the  year  1912  that  seemingly  would  have  properly  come  within  their 
jurisdiction  in  this  respect.  Over  70  per  cent,  of  these  were  transferred 
to  institutions  for  the  care  of  the  insane,  where  they  were  still  subject  to 
removal  by  this  Board.     (Table  XXXHI.) 

(d)  Relief  from  Non-Residents  of  New  York  City 

At  the  time  when  Bellevue  and  the  allied  hospitals  formed  integral 
parts  of  the  Department  of  Public  Charities,  it  was  within  the  power  of  the 
Commissioner  of  Charities  to  serve  notice  upon  the  overseers  of  the  poor 
of  the  town  or  city  within  the  State  from  which  poor  persons  had  come  to 
seek  relief  in  New  York  City,  that  they  would  be  expected  to  pay  for  the 
expense  of  such  poor  persons  in  these  hospitals  and  the  other  institu- 
tions of  the  Department  of  Charities.  Unless  the  authorities  receiving  this 
notice  should  deny  that  their  town  or  county  was  liable  for  the  support  of 
this  person  within  30  days  after  the  receipt  of  this  notice,  the  law  precluded 
them  from  protesting  it,  and  they  became  liable  for  this  expense. 

The  medical  facilities  afforded  by  the  City  of  New  York  have  drawn 
many  people  from  other  localities  within,  as  well  as  without,  the  State,  to 
receive  free  treatment  here.  In  the  year  1912,  of  2,431  admissions  of  non- 
residents of  the  City  to  Bellevue  Hospital,  the  records  indicated  that  529 
patients,  or  21.8  per  cent,  of  the  whole,  had  been  in  New  York  City  less  than 
24  hours;  that  641,  or  26.4  per  cent.,  had  been  in  the  City  less  than  3  days; 
810,  or  33.3  per  cent.,  less  than  i  week;  and  1,161,  or  47.7  per  cent,  of  the 
total,  were  patients  who  had  been  in  the  City  less  than  i  month;  58.4  per 
cent,  were  patients  who  had  been  in  the  City  less  than  2  months,  while  2,082, 
or  85.6  per  cent,  of  the  non-residents  admitted  to  Bellevue  in  1912,  accord- 
ing to  their  records,  had  been  in  the  City  less  than  6  months.  (Table 
XXXV.) 

No  request  was  made  on  the  part  of  the  Board  of  Trustees  of  Bellevue 
and  Allied  Hospitals  to  the  county  superintendents  of  the  poor  within  whose 
jurisdiction  patients  had  established  settlements  to  reimburse  the  City  for  the 
expense  of  their  medical  care  and  maintenance  in  Bellevue  Hospital,  or  to 
remove  chronic  patients  from  the  Hospital.  Neither  was  any  request  made 
to  the  Department  of  Public  Charities  to  make  such  a  demand  upon  these 
authorities  in  behalf  of  Bellevue. 


140  HOSPITAL  COMMITTEE 

{e)  Maintenance  of  State  Poor 

During  the  year  1912  there  were  received  into  Bellevue  Hospital  802 
patients,  of  whom  more  than  one-half  were  aliens,  whom  the  records  show 
had  had  less  than  a  2  months  residence  in  the  State  of  New  York  before 
admission.  Of  these  patients,  39  had  had  some  payment  made  toward  the 
expense  of  their  maintenance  in  the  Hospital,  the  amount  having  been 
$470.00.  The  remaining  763  patients,  however,  were  maintained  as  public 
charges  upon  the  City  of  New  York,  at  a  current  expense  of  $13,283.59, 
without  any  reimbursement,  although,  under  the  definition  of  the  Poor 
Law,  quoted  in  this  report,  they  were  State  Poor  (Table  XXXIV).  These 
763  admissions  formed  38  per  cent,  of  the  2,011  patients  non-resident  in 
New  York  City  whose  time  of  stay  in  the  State  was  indicated.  There 
were,  however,  420  patients  who  were  also  non-residents  of  New  York 
City  but  for  whom  the  length  of  stay  in  the  State  was  not  recorded.  If  38 
per  cent,  of  these  also  had  been  included  with  those  who  were  less  than 
2  months  in  the  City  there  would  have  been  a  total  of  962  admissions 
of  State  Poor  patients,  maintained  at  an  estimated  expense  to  New  York 
City  of  $16,799.39. 

Although  such  a  large  proportion  of  the  non-residents  in  this  Hospital 
were  State  Poor,  it  would  unquestionably  have  been  impracticable  to  have 
admitted  all  of  them  directly  to  even  the  nearest  State  Almshouse,  which  is 
the  City  Home  on  Blackwell's  Island.  Only  a  small  proportion  of  them 
were  transferred  to  this  Home  upon  leaving  Bellevue. 

Upon  the  State  Register  at  this  City  Home  are  entered  the  names  of 
126  individuals  for  whose  maintenance  it  was  said  bills  had  been  rendered 
to  the  State  Board  of  Charities  in  accordance  with  the  contract  between  that 
Board  and  the  Department  of  Public  Charities.  Analysis  of  the  records 
of  these  126  poor  persons  shows  that  more  than  two-thirds  of  them  had  been 
inmates  of  hospitals  and  institutions  other  than  the  City  Home,  and  that 
2  of  them  had  been  patients  in  Bellevue  Hospital.     (Table  LII.) 

No  request  was  made  by  the  Board  of  Trustees  of  Bellevue  and  Allied 
Hospitals  upon  the  State  Board  of  Charities  to  reimburse  the  City  for  the 
expense  of  any  of  these  persons,  nor  did  these  Trustees  make  any  such  re- 
quest through  the  Commissioner  of  Public  Charities. 


Medical  and  Lay  Examination  of  Patients  Admitted  to  Bellevue 
Hospital  in  1913 

Although  the  study  of  the  records  of  Bellevue  Hospital  for  1912,  already- 
discussed  at  length  in  this  Report,  was  made  very  carefully,  and,  it  is  be- 
lieved, fairly,  these  records  were  not  supplemented  by  a  direct  investigation 
of  the  patients  involved.  Believing  that  such  an  investigation  would  be  of 
great  value  in  discovering  the  sources  of  the  burden  upon  the  City's 
charity,  an  examination  was  made,  as  far  as  practicable,  of  every  patient 
admitted  to  Bellevue  Hospital  from  May  19,  1913,  to  June  18,  1913,  in- 
clusive. 

The  total  number  of  patients  admitted  during  this  period  was  3,454, 
according  to  the  Hospital  records.  The  Committee  investigated  3,451  cases, 
which  was  practically  the  same  number.  Consequently,  the  Hospital's  num- 
ber was  accepted,  and  3  cases  were  added  to  the  Committee's  number  and 
counted  among  the  histories  in  which  clear  data  was  not  obtained.     (Table 

xxxvin.) 

The  examination  was  carried  on  by  the  investigators  and  physicians  in 
the  service  of  this  Committee.  The  lay  investigators  examined  every  pa- 
tient possible  that  was  admitted  to  the  wards  of  the  Hospital  during  this 
period.  When  the  lay  investigators  discovered  patients  that  were  aliens  or 
non-residents  of  New  York  City,  the  cases  were  referred  to  the  medical 
examiners  of  the  Committee,  who  followed  them  up  with  direct  physical 
examination  of  the  patients  and  a  careful  study  of  their  medical  records  in 
the  Hospital.  As  the  investigation  was  not  carried  outside  of  the  gates  of 
the  institution,  it  was  found  impossible  to  obtain  sufficient  information  to 
determine  the  citizenship  and  residence  of  every  patient  admitted.  A  cer- 
tain number  of  patients  died  before  full  information  could  be  secured  from 
them,  and  it  was  not  feasible  to  see  their  friends  or  relatives  at  the  Hospital. 
Also,  in  a  good  many  cases  the  subsequent  examination  of  the  medical  ex- 
aminers could  not  be  made  before  the  discharge  or  transfer  of  the  patients 
who  had  been  seen  by  the  lay  examiners,  as  this  Committee  refrained,  as  far 
as  possible,  from  interrupting  the  work  of  the  Hospital.  In  certain  of  the 
psychopathic  cases,  for  very  evident  reasons,  the  history  could  not  be  com- 
pleted at  the  Hospital.  On  account  of  the  advanced  or  immature  age  of 
other  patients,  complete  histories  of  their  cases  could  not  be  secured  within 
the  Hospital,  although  every  effort  was  made  to  interview  relatives  and 
friends  upon  their  visits. 

Consequently,  in  these  3,454  admissions  there  were  635  cases  in  which 
the  histories  could  not  be  completed  sufficiently  for  a  positive  statement  to  be 
made  that  these  patients  were  aliens,  citizens,  or  non-residents  of  New  York 
City,  qr  that  they  were  dependent  from  causes  existing  prior  or  subsequent 
to  their  entrance  into  the  country  or  City.  In  the  effort  to  give  a  perfectly 
sound  statement,  all  cases  with  incomplete  histories  were  rigidly  excluded 
from  those  classified  according  to  the  propriety  or  impropriety  of  their  de- 
pendence at  municipal  expense. 

141 


142  HOSPITAL   COMMITTEE 

Every  care  was  exercised  to  conduct  this  examination  under  as  nearly 
normal  conditions  as  possible.  Tlie  lay  and  medical  examiners  of  the  Com- 
mittee did  not  tell  the  patients  under  examination  of  the  purpose  of  their 
inquiries,  and  no  encouragement  was  given  any  of  the  patients  to  state  that 
they  were  aliens  with  the  hope  of  their  being  returned  to  other  countries. 
It  is  assumed  that  the  patients  had  no  knowledge  but  that  they  were  being 
examined  by  the  regular  employees  associated  with  the  Hospital,  although 
this  statement  was  not  made  to  them.  As  a  matter  of  fact,  though  every 
effort  was  made  to  conduct  this  investigation  with  as  undisturbed  condi- 
tions as  possible,  it  is  believed  that  the  findings  of  this  Committee  will  show 
proportions  of  aliens  and  of  non-residents  of  the  City  below  what  normally 
exists  in  the  Hospital,  because  in  spite  of  the  efforts  of  the  examiners  to 
avoid  such  an  occurrence  there  was  found  to  be  an  increasing  reluctance  on 
the  part  of  the  patients  toward  the  latter  part  of  the  investigation  to  admit 
that  they  were  aliens  or  non-residents  of  the  City. 

Citizens 

The  findings  of  the  Committee  will  be  found  tabulated  in  Tables 
XXXVni  to  XLI.  It  may  be  seen  that,  of  the  2,819  admissions  of  patients 
for  which  a  sufficiently  complete  history  was  obtained  to  admit  of  their 
classification,  1,793,  or  63.6  per  cent.,  were  patients  who  claimed  citizenship 
in  this  country  and  also  a  residence  in  New  York  City  of  a  year's  duration. 
No  effort  was  made  on  the  part  of  this  Committee  to  disprove  their  claims 
by  investigation  outside  of  the  Hospital.  Also,  164  patients,  or  5.8  per  cent. 
of  the  2,819,  professed  to  be  citizens  of  this  country,  although  not  legal 
residents  of  New  York  City.  This  would  make  a  total  of  1,957  patients 
who  claimed  United  States  citizenship. 

The  admission  records  of  Bellevue  Hospital  show  that  for  this  period 
of  31  days  covered  by  the  examination,  the  3,454  admissions  were  divided 
as  follows:  1,726  born  in  the  United  States;  1.707  born  in  foreign  coun- 
tries; and  21  whose  nativity  was  unknown.  Thus,  it  will  be  seen  that  the 
proportion  of  foreign  born,  according  to  the  records  of  the  Hospital,  is 
much  lower  than  the  proportion  of  patients  who  claimed  to  be  citizens  of 
the  United  States  when  under  investigation. 

Aliens 

There  were  862  cases  of  patients  examined  by  the  Committee  who  ac- 
knowledged their  foreign  birth  and.  that  they  had  not  acquired  citizenship 
in  the  United  States  (Table  XXXVIII).  A  thorough  examination  of  these 
patients  regarding  their  social  conditions  by  a  lay  investigator,  and  of  their 
previous  medical  history  by  physicians  who  determined  their  physical 
diagnosis  and  prognosis,  made  possible  their  classification  as  appears  in 
Tables  XXXVIII  to  XLI. 

A  digest  of  the  histories  of  all  aliens  of  this  class  whose  deportation 
seemed  to  be  warranted  will  be  found  in  the  Appendix  attached  to  this 
Report.  There  were,  as  may  be  seen  in  Table  XXXVIII,  383  deportable 
aliens,  comprising  13.6  per  cent,  of  the  total  cases  classified  by  the  Com- 
mittee. 

These  383  deportable  aliens  were  classified  as  follows:  Aliens  in  the 
United  States  in  violation  of  the  Federal  Immigration  Law,  40;  aliens  de- 


ALIENS  AND   NON-RESIDENTS 


143 


portable  under  the  Federal  Immigration  Law,  63;  aliens  deportable  under 
the  New  York  State  Charities  Law,  213;  aliens  deportable  under  the  State 
Insanity  Law  with  the  consent  of  responsible  relatives  or  friends,  67.  No 
effort  was  made  by  the  examiners  to  obtain  the  consent  mentioned  in  con- 
nection with  the  last  class. 

These  383  aliens  received  4,144  days  of  treatment  in  Bellevue  Hospital 
prior  to  September  9,  1913,  at  an  estimated  expense  to  the  City  of 
$7,500.64.  This  expense  includes  a  proportion  of  the  general  administra- 
tive expense  of  the  Department,  but  does  not  include  any  charge  accruing 
from  purchase  of  grounds,  construction  or  equipment  of  buildings,  etc. 
The  only  money  received  by  the  Hospital  up  to  September  i,  1913,  in 
payment  of  the  expense  of  these  383  aliens  was  the  sum  of  $16.50,  paid'for 
I  patient. 

A  large  number  of  aliens  was  found  in  the  Hospital  whose  removal 
might  not  have  been  a  humane  act  because  of  the  presence  of  near  rela- 
tives in  this  country,  or  their  lack  of  such  in  Europe,  or  because  their  de- 
pendence seemed  likely  to  be  of  a  temporary  nature.  These  appear  in 
Table  XXXVIII,  in  Class  I,  subdivisions  5a  and  5b.  There  were  479  such 
aliens  among  the  admissions  to  the  Hospital  in  the  31  days,  forming  17  per 
cent,  of  the  total  patients  for  whom  complete  histories  were  obtained  by 
the  examiners. 

These  479  aliens  were  divided  into  two  classes :  those  whose  histories 
strongly  indicated  that  they  would  become  chronic  or  recurrent  dependents 
upon  the  City,  consisting  of  142  cases,  and  those  whose  dependence  upon 
the  City  seemed  likely  to  be  temporary,  of  whom  there  were  337  cases. 
The  total  days  of  stay  of  the  142  aliens  that  were  apparently  chronic  or  re- 
current dependents  was  1,402,  at  an  expense  of  $2,537.62.  The  337  whose 
dependence  seemed  likely  to  be  temporary  remained  in  the  Hospital  an 
^ggi'egate  of  4,443  days,  at  an  expense  of  $8,041.83.  For  4  of  this  latter 
class  of  patients,  there  was  received  by  the  Hospital  the  sum  of  $102.50. 
The  total  days  of  stay,  therefore,  of  those  aliens  whose  deportation  might 
have  been  a  matter  of  debate  was  5,845,  and  their  maintenance  cost 
$10,579.45,  with  total  receipts  of  only  $102.50. 

In  Summary  B,  Table  XXXVIII,  is  shown  the  total  number  of  aliens 
admitted  to  the  Hospital  in  31  days.  There  were  862  such  patients,  with 
an  aggregate  of  9,989  days  of  stay,  at  an  expense  to  the  City  of  $18,080.09, 
up  to  September  9,  1913.  Of  this  total  number  of  patients,  payments  were 
made  for  but  5,  amounting  to  only  $119.  These  figures,  however,  are  for 
only  those  cases  in  which  the  histories  could  be  completed.  There  were 
635  cases  of  incomplete  histories,  or  22.5  per  cent,  in  the  total  number  of 
3,454  admissions  in  the  month.  To  reach  an  estimate  of  the  total  expense 
of  aliens  during  the  year  it  is  assumed  that  there  would  have  been  the 
same  proportions  of  these  635  aliens  falling  into  the  different  classes  de- 
scribed, in  each  month  of  the  year.  The  total  admissions  for  the  month, 
3,454,  approximated  the  average  monthly  admissions  for  the  year  1912. 

On  the  basis  of  this  showing  of  the  period  of  31  days  there  would  be 
received  into  Bellevue  Hospital  in  a  year  12,671  alien  patients,  whose  main- 
tenance would  cost  the  City  $265,777.33.  If  the  Hospital  received  the  same 
proportionate  amount  monthly,  and  this  amount  were  deducted  from  the  ex- 
pense, the  net  annual  cost  to  the  City  for  the  support  of  alien  patients  in 
this  one  institution  would  be  $264,027.96,  exclusive  of  the  cost  connected 
with  the  erection  and  equipment  of  buildings  and  the  purchase  of  site. 

On  the  basis  of  the  proportion  found  to  exist  within  a  period  of  31 


144  HOSPITAL  COMMITTEE 

days  in  the  cases  with  histories  sufficiently  complete  to  classify  there  would 
be  received  in  this  Hospital  annually  as  follows : 

A  total  of 

688  aliens  whose  presence  in  the  United  States  would  constitute  a  viola- 
tion of  the  Federal  Immigration  Law,  whose  maintenance  would 
cost  the  City $14,474.21 

926     additional  aliens  deportable  from  this  country  under  the  Federal 

Immigration  Law,  whose  maintenance  would  cost  the  City 19,769.00 

3,131     aliens  deportable  under  the  State  Charities  Law,  whose  maintenance 

would  cost  the  City 65,799.11 

985     aliens  deportable  (with  consent)  under  the  State  Insanity  Law, 

whose  maintenance  would  cost  the  City 10,217.09 

Making  a  total  number  of 
5,630    aliens,  removable  under  the  Federal  and  State  Laws,  whose  main- 
tenance would  cost  the  City 8110,259.41 

Also,  there  would  be 
7,041     aliens  whose  deportation  might  not  have  been  proper,  but  whose 

maintenance  would  cost  the  City 155,517.92 

As  will  be  seen  in  the  cumulative  totals  of  aliens,  in  Table  XXXVIII, 
among  the  862  alien  patients  admitted  in  3 1  days  there  was  i  who  had  been 
in  the  United  States  less  than  i  day;  5  less  than  3  days;  8  less  than  i  week; 
21  less  than  i  month;  33  less  than  2  months;  64  less  than  6  months;  119 
less  than  i  year;  251  less  than  3  years;  and  363  less  than  5  years. 

Of  the  total  of  383  deportable  aliens,  i  had  been  in  the  United  States  less 
than  I  day;  5  less  than  3  days;  7  less  than  i  week;  14  less  than  i  month; 
23  less  than  2  months;  42  less  than  6  months;  76  less  than  i  year;  142  less 
than  3  years;  and  208  less  than  5  years. 

Of  the  total  alien  patients  29.2  per  cent,  had  been  in  the  United  States 
less  than  3  years;  42.1  per  cent,  less  than  5  years.  It  is  assumed  that  for  a 
year  the  number  of  patients  admitted  who  had  been  in  the  United  States  for 
the  same  periods  would  be  twelve  times  as  many  as  those  during  these  31 
days. 

While  it  is  interesting  to  know  that  862  aliens  were  admitted  to  Belle- 
vue  Hospital  in  31  days  whose  maintenance  cost  the  City  $18,080.09,  i* 
would  perhaps  be  a  matter  of  even  greater  interest  to  know  the  expense 
of  the  alien  patients  in  the  United  States  less  than  a  year,  as  within  this 
period  the  expense  of  the  aliens  deported  by  consent  and  of  those  who 
have  become  public  charges  from  causes  existing  prior  to  landing  may  be 
paid  out  of  the  United  States  "immigration  fund."  A  showing  of  the  total 
days  of  stay  of  all  aliens  found  to  have  been  in  the  United  States  less  than 
I  year  that  were  admitted  to  the  Hospital  within  the  period  of  31  days, 
will  be  found  in  Table  XXXIX.  In  this  table  there  appears  also  the  total 
number  of  aliens  who  had  been  in  the  United  States  under  3  years,  the 
period  within  which  aliens  may  be  deported  under  the  Federal  Immigra- 
tion Law.  whose  expense,  after  the  date  of  the  issuance  of  their  war- 
rant for  deportation,  can  be  paid  out  of  the  United  States  "immigration 
fund." 

In  the  same  table,  also,  appears  the  total  number  of  alien  patients  ad- 
mitted to  the  Hospital  during  these  31  days  who  had  been  less  than  5  years 
in  the  United  States;  their  aggregate  days  of  stay  up  to  September  9,  1913; 


ALIENS  AND   NON-RESIDENTS  145 

and  the  total  expense  to  that  date.  Under  the  application  of  the  former 
State  Emigration  Law  the  expenses  of  all  such  aliens  might  have  been 
paid  for  out  of  the  funds  of  the  State  Commissioners  of  Emigration,  either 
in  the  institutions  under  their  supervision,  or  in  other  institutions." 

The  estimated  total  number  of  days  of  stay  and  expense  for  each  of  these 
groups  of  patients  for  a  period  of  i  year,  on  the  basis  of  the  showing  of 
the  cases  that  could  be  classified  for  31  days,  will  also  be  found  in  this 
table. 

Aliens  in  the  United  States  Less  Than  One  Year 

There  were  admitted  to  Bellevue  Hospital  119  aliens,  in  the  period  of 
31  days  covered  by  the  examination,  who  had  been  in  this  country  less 
than  a  year.  These  remained  in  the  Hospital  1,364  days,  at  an  expense  to 
the  City  of  $2,468.84.  On  the  basis  of  this  showing  for  i  month  the  esti- 
mated total  number  of  this  class  of  aliens  admitted  to  the  Hospital  in  a 
year  would  be  1,749,  and  their  days  of  stay  20,051,  at  an  expense  to  the  City 
of  $36,291.95. 

Of  these  119  aliens  found  to  have  been  in  this  country  less  than  a  year 
76  were  deportable.  They  had  been  in  the  Hospital  854  days,  at  an  expense 
of  $1,545.74.  Also,  there  were  43  whose  deportation  might  not  have  been 
justified,  who  remained  in  the  Hospital  510  days,  at  an  expense  of  $923.10. 
It  will  be  observed  that  the  number  of  aliens  among  those  in  the  country 
less  than  a  year,  who  were  deportable,  was  nearly  twice  as  large  as  those 
who  might  not  justifiably  be  deportable. 

The  number  for  i  year  of  those  deportable  would  be  1,117  aliens,  as 
compared  with  632  not  deportable,  and  the  expense  for  deportable  aliens 
would  be  $22,722.38,  as  compared  with  $13,569.57  for  those  whose  deporta- 
tion might  not  have  been  humane.  No  reference  has  been  made  in  this 
connection  to  the  money  received  by  the  City  for  any  of  these  patients, 
because  the  total  amount  of  $119  received  for  all  aliens,  which  has  already 
been  mentioned,  is  too  insignificant  to  deserve  consideration. 

Of  these  119  aliens  found  to  have  been  in  this  country  less  than  i  year, 
3  had  been  removed  by  the  State  Board  of  Charities,  and  none  by  the 
United  States  Government,  prior  to  September  i,  1913,  according  to  the 
monthly  report  of  removals  of  the  State  Board  of  Charities. 

Aliens  in  the  United  States  Less  Than  Three  Years 

There  were  251  aliens  admitted  in  the  period  of  examination  who  had 
been  in  this  country  less  than  3  years  (inclusive  of  those  who  had  been  in 
the  country  less  than  i  year).  These  remained  in  the  Hospital  3,168  days, 
at  a  total  expense  of  $5,734.08  for  their  hospital  care.  The  proportion  for 
a  year  would  be  3,690  such  aliens,  remaining  46,570  days,  at  an  expense  to 
the  City  of  $84,290.98.  According  to  the  facts  gathered  142  of  these  aliens 
were  deportable.  These  had  been  in  the  Hospital  1,788  days,  at  an  expense 
of  $3,236.28.  In  comparison  with  this  there  were  log  aliens  whose  de- 
portation might  not  have  been  humane,  who  had  been  in  the  Hospital  1,380 
days,  at  an  expense  of  $2,497.80. 

The  total  number  in  the  class  of  deportable  aliens  for  a  year  on  the 
basis  of  this  showing  would  be  2,087,  whose  maintenance  would  cost  the 
City  $47,573.32;  and  there  would  be  1,602  aliens  whose  deportation  might 
not  have  been  justified  but  whose  maintenance  would  cost  the  City  $36,- 


146  HOSPITAL   COMMITTEE 

717.66.  Practically  nothing  was  received  by  the  City  for  the  expense  of  any 
of  these  aliens  prior  to  September  i,  1913.  Of  the  251  aliens  found  to  have 
been  in  this  country  less  than  3  years,  4  had  been  removed  by  the  State 
Board  of  Charities,  and  none  by  the  United  States  Immigration  Service, 
according  to  the  monthly  reports  of  the  State  Board  of  Charities. 

Alieiis  in  the  United  States  Less  Than  Five  Years 

There  were  363  aliens  admitted  in  the  31  days  who  had  been  in  the 
United  States  less  than  5  years  (inclusive  of  those  here  less  than  3  years). 
The  aggregate  days  of  stay  of  these  patients  prior  to  September  9,  1913,  was 
4,284,  at  an  expense  of  $7,754.04.  The  estimated  number  for  a  year 
would  be  5,336  aliens,  with  62,975  days  of  hospital  maintenance,  at  an  ex- 
pense of  $113,984.39. 

These  admissions  may  be  divided  as  follows :  208  deportable  aliens 
maintained  at  an  expense  of  $4,164.81,  and  155  ahens  whose  deportation 
is  not  recommended  maintained  at  an  expense  of  $3,589.23.  The  annual 
number  of  those  deportable  would  be  3,058,  and  their  annual  expenses 
$61,222.71 ;  in  comparison  with  the  annual  number  of  2,279  aliens  whose 
deportation  would  be  of  doubtful  advisability,  treated  at  an  annual  ex- 
pense of  $52,761.68.  Practically  nothing  was  paid  to  the  City  for  these 
aliens.  Of  the  aliens  found  to  have  been  in  this  country  less  than  5  years, 
5  were  removed  by  the  State  Board  of  Charities,  and  none  were  removed 
by  the  United  States  Immigration  Service. 

This  indicates  that  the  City  is  bearing  an  expense  of  $113,984  annually 
for  the  maintenance  in  this  one  hospital  of  aliens  who  have  been  in  the 
country  less  than  5  years,  exclusive  of  the  burden  for  the  erection  of  build- 
ings, acquisition  of  grounds,  and  kindred  expenses.  Under  the  provisions 
of  the  former  State  Emigration  Law  the  expense  of  all  these  patients 
would  have  been  borne  out  of  funds  created  by  the  collection  of  a  head 
tax  from  immigrants,  and  these  patients  would  either  have  been  cared  for 
in  the  special  institutions  of  the  State  Emigration  Commission,  or  in  other 
public  institutions.  Under  the  administration  of  the  Federal  Immigration 
Law,  which  has  superseded  the  State  Law,  practically  the  whole  of  the  heavy 
burden  of  expense  falls  upon  the  municipality,  as  the  payments  from  the 
Federal  "immigration  fund"  to  the  City  are  insignificant. 

Aliens,  Patients  from  Causes  Existing  Prior  to  Landing 

As  has  been  clearly  shown  in  this  Report,  an  important  proportion  of 
the  patients  in  Bellevue  Hospital  were  aliens  who  had  the  conditions  re- 
sulting in  their  presence  at  the  Hospital  as  public  charges  before  they  were 
landed  in  this  country.  Their  cases  were  taken  up  for  special  considera- 
tion. The  Federal  Immigration  Law,  in  the  provisions  that  most  directly 
affect  the  hospitals,  specifies  certain  diseases  for  which  aliens  are  to  be 
excluded  from  this  country,  and  also  provides  for  a  certain  general  class 
of  causes  that  have  been  certified  to  by  a  doctor  of  the  United  States 
Public  Health  Service  as  "affecting  ability  to  earn  a  living,"  for  which 
immigrants  may  be  debarred  from  landing.  Consequently,  these  cases 
have  been  separated  according  to  the  distinctions  in  the  Federal  Law. 
The  diagnoses  of  the  185  cases  judged  by  the  investigators  and  medical 
examiners  of  this  Committee  to  have  had  the  causes  of  their  dependence 
prior  to  landing  appear  in  Table  XLII.     The  185  patients  represented  by 


ALIENS   AND   NuN-RESIDENTS  147 

these  diagnoses  are  the  same  as  those  that  appear  in  Table  XXXVIII,  as 
follows : 

Class  I. 

1.  Aliens  in  the  United  States  in  violation  of  the  Federal  Immigration  Law ....     40 

2.  Aliens  deportable  under  the  Federal  Immigration  Law 63 

3a.      Aliens  deportable   under  the   State   Charities   Law  from   causes  existing 

prior  to  landing 30 

4a.       Aliens   deportable   (with   consent)  under    the    State   Insanity  Law   from 

causes  existing  prior  to  landing 52 

Total 185 

Of  these  185  cases,  no,  or  59.5  per  cent.,  were  cases  for  mandatory- 
exclusion  from  this  country  by  the  Federal  Immigration  Law,  and  75  pa- 
tients, or  40.5  per  cent.,  were  certifiable  as  having  conditions  "affecting 
ability  to  earn  a  living."  The  no  cases  of  patients  whose  admission  to 
this  country  was  forbidden  by  the  Federal  Immigration  Law  consisted  of 
10  cases  of  pulmonary  tuberculosis;  15  cases  of  venereal  diseases;  81  psycho- 
pathic cases ;  2  cases  of  epilepsy ;  and  2  imbeciles. 

The  most  frequent  diagnosis  among  the  patients  certifiable  as  having 
conditions  "affecting  ability  to  earn  a  living"  was  chronic  alcoholism,  with 
which  26  patients  were  suffering.  Chronic  cardiac  diseases  were  found  in 
14  aliens;  chronic  gastritis  in  6;  various  joint  affections  in  5;  and  chronic 
arthritis  in  i.  Also,  there  were  3  patients  with  chronic  otitis  media;  5 
pregnant  women,  i  of  whom  had  a  childbirth,  and  another  an  abortion; 
and  I  case  of  exophthalmic  goiter.  There  were  also  individual  cases  of  the 
following  diagnoses  :  Urethral  fistula ;  hypospadias ;  salpingitis ;  hernia ; 
malignant  tumor;  chronic  emphysema;  empyema;  congenital  malformation 
of  toe ;  malaria ;  asthma ;  erysipelas ;  carbuncle ;  and  acute  alcoholism. 

When  it  is  borne  in  mind  that  to  reach  the  number  of  cases  that  would 
be  admitted  to  Bellevue  Hospital  in  a  year  these  figures  must  be  multiplied 
by  the  number  of  months,  and  also  that  there  must  be  added  to  them  22.5 
per  cent.,  in  order  to  represent  the  proportion  of  cases  with  incomplete  his- 
tories during  the  31  days,  it  will  be  seen  that  the  number  of  aliens  who 
would  come  into  the  Hospital  within  a  year  as  public  charges  from  causes 
existing  prior  to  landing  is  large.  For  example,  there  would  be  1,345  aliens 
admitted  to  this  one  institution  during  a  year  whose  entrance  to  this  coun- 
try is  forbidden  by  the  Federal  statutes.  Also,  there  would  be  917  patients 
in  the  Hospital  in  a  year  certifiable  to  by  the  doctors  of  the  United  States 
Public  Health  Service  as  having  conditions  "affecting  ability  to  earn  a  liv- 
ing." The  total  aliens  who  would  be  patients  from  causes  existing  prior 
to  landing  would  be  2,262  for  a  year. 

Conditions  Suggested  as  Accounting  for  Patients  from  Prior  Causes 

It  is  one  thing  to  show  that  the  Immigration  Law  has  not  protected  this 
country  entirely  from  the  burden  of  alien  dependents,  but  it  is  quite  an- 
other thing  to  know  to  what  causes  existing  at  the  time  of  their  entry  into 
this  country  may  be  attributed  the  presence  of  immigrants  in  our  institu- 
tions. With  this  object  in  view,  the  method  of  the  medical  examination  of 
immigrants  by  the  immigration  authorities  was  inquired  into  and  observa- 


148  HOSPITAL   COMMITTEE 

tion  made  of  the  conditions  under  which  these  aHens  were  examined.  Fur- 
thermore, a  search  was  made  of  the  ships'  manifests  for  two-thirds  of  the 
aliens  in  this  country  less  than  6  years,  to  discover  if  there  was  any  annota- 
tion upon  the  ships'  manifests  at  Ellis  Island  that  any  of  these  patients  had 
been  certified  by  the  doctors  as  mandatorily  excludable ;  as  having  conditions 
"afifecting  their  ability  to  earn  a  Hving" ;  or  that  any  had  been  referred  to 
boards  of  special  inquiry.  Of  the  whole  number  so  examined  in  the  govern- 
ment records,  only  2  individuals  were  found  to  have  come  before  a  board  of 
special  inquiry.  This  search  seemed  so  unproductive  of  results  that,  on 
account  of  the  pressure  of  other  work,  it  was  abandoned  without  the  records 
for  all  the  cases  having  been  examined. 

Some  of  the  conditions  surrounding  the  examination  of  immigrants  at 
landing,  however,  and  the  cases  whose  presence  in  the  Hospital  might  reason- 
ably be  attributed  to  these  conditions  will  be  found  in  Table  XLIII.  There 
were  105  such  cases  among  the  185  patients  admitted  to  Bellevue  Hospital  in 
the  period  of  31  days  as  public  charges  from  causes  existing  prior  to  landing. 
It  would  have  been  difficult  or  impossible  to  detect  the  remaining  So  cases, 
even  with  far  more  adequate  facilities  than  are  available  for  the  United 
States  Public  Health  Service  to-day,  principally  on  account  of  the  probably 
incipient  or  inactive  stages  of  their  conditions. 

The  105  patients  whose  condition  causing  their  presence  in  the  Hospital 
could  probably  have  been  detected  with  proper  facilities,  appear  to  have  es- 
caped detection  for  the  following  reasons :  There  were  40  cases  whose  pres- 
ence as  dependents,  sometimes  within  a  very  few  days  after  landing,  may 
have  occurred  because  of  the  lack  of  a  quiet  place  for  the  examination  of  the 
hearts  and  lungs  of  the  immigrants,  and  the  lack  of  facilities  for  undressing 
them.  There  were  40  other  cases  that  it  seems  fair  to  say  may  have  been 
allowed  access  to  the  country  on  account  of  the  lack  of  medical  interpreters 
at  the  disposal  of  the  examining  officers  of  the  United  States  Public  Health 
Service,  and  the  lack  of  facilities  for  detaining  suspected  psychopathic 
cases.  The  insufficient  oversight  by  the  immigration  authorities  of  the 
crews  of  ships  and  the  ease  with  which  members  of  these  crews  can  desert 
seemed  responsible  for  the  presence  of  6  aliens  in  the  Hospital.  The  lack 
of  a  proper  place  for  the  examination  of  discharged  seamen  would  account 
for  5  more.  Two  cases  of  epilepsy  may  have  been  hard  to  detect  without 
prior  medical  history;  and  i  case  of  congenital  malformation  of  the  toe  may 
have  appeared  of  insignificant  consequence  in  the  examination  of  the  immi- 
grants. There  was  i  interesting  case  of  a  patient  landed  at  a  private  hospi- 
tal by  the  permission  of  the  United  States  immigration  authorities,  and  trans- 
ferred from  this  hospital  to  become  a  charge  at  the  City's  expense  (not  re- 
imbursed to  the  City).  Finally,  there  were  10  cases  for  whose  presence 
in  the  country  it  seemed  diificult  to  assign  any  reason  but  oversight  on 
the  part  of  the  medical  examiners.  The  diagnoses  in  these  10  cases  were : 
imbecility  in  2  cases ;  senile  dementia  in  i  case,  at  Bellevue  Hospital  within 
2  months  after  landing:  chronic  otitis  media  in  2  cases;  exophthalmic  goiter 
in  I  case ;  paresis  in  i  case,  in  Bellevue  within  6  weeks  after  landing ;  chronic 
pulmonary  tuberculosis  in  i  case,  in  Bellevue  when  only  3I/2  months  in 
the  country ;  parturition  in  i  case,  after  6  weeks  in  the  United  States ;  and 
chronic  emphysema  in  i  case. 

Among  these  105  cases  were  55  that  were  mandatorily  excludable,  and 
48  that  could  have  been  certified  to  as  having  conditions  "affecting  ability 
to  earn  a  living."  Of  the  2  other  cases,  i  possibly  seemed  trivial  on 
entry,  and  the  other  was  the  case  of  the  woman  in  the  private  hospital 


ALIENS  AND   NON-RESIDENTS  149 

referred  to.  The  mandatorily  excludable  cases  consisted  of  28  insane  im- 
migrants; 15  with  venereal  diseases  in  the  active  stage;  8  with  pulmonary 
tuberculosis;  2  with  epilepsy;  and  2  imbeciles. 

Alien  Seamen 

One  very  interesting  fact  developed  during  this  investigation  was  the 
presence  of  alien  seamen  in  the  Hospital,  both  those  who  claimed  to  have 
been  discharged  from  their  ships  and  those  who  had  deserted,  as  may 
be  seen  by  referring  to  the  Appendix  of  this  Report  for  the  digest  of  the 
histories,  tmder  Class  I — i  AHens  in  the  United  States  in  violation  of  the 
Federal  Immigration  Law,  and  also  in  Class  I — 2  Aliens  deportable  under 
the  Federal  Immigration  Law.  In  Class  I — i,  over  25  per  cent,  of  the 
patients  were  seamen.  In  most  of  these  cases  competent  medical  ex- 
amination by  the  United  States  Immigration  authorities  should  have  de- 
tected the  conditions  which  led  to  the  dependence  of  these  alien  seamen. 
In  the  case  of 'only  i  was  any  payment  made  by  the  steamship  companies. 
On  the  basis  of  those  found  in  the  31  days  among  the  completed  cases 
there  would  be  160  alien  seamen  admitted  to  this  one  hospital  in  a  year 
who  would  be  there  in  violation  of  the  Federal  Immigration  Law. 

There  is  no  statute  known  in  the  Immigration  Law  which  compels 
steamship  authorities  to  present  seamen  to  the  immigration  authorities  be- 
fore discharging  them,  although  there  was  a  Regulation,  issued  under  the 
former  Department  of  Commerce  and  Labor,  based  upon  what  was  con- 
sidered the  intent  of  the  law,  requiring  discharged  seamen  to  be  so  pre- 
sented. Again,  it  is  understood  that  the  seamen  that  are  voluntarily  pre- 
sented by  the  steamship  companies  for  examination  are  brought  either  to 
the  Manhattan  pier  of  the  Ellis  Island  ferry,  or  are  presented  at  the  time 
of  landing  with  the  second  cabin  passengers.  In  neither  case  are  there 
facilities  for  undressing  these  seamen  for  thorough  examination. 

Non-Residents  of  New  York  State 

The  City  is  interested  in  knowing  not  only  what  proportion  of  its 
burden  comes  to  it  from  other  countries,  but  also  to  what  extent  it  is 
assuming  the  responsibility  of  caring  for  those  who  have  not  gained  a  legal 
settlement  in  this  State.  Among  the  2,819  patients  who  were  classified 
according  to  their  citizenship  and  were  tabulated  in  Table  XXXVIII,  which 
has  already  been  discussed,  there  were  1,793  citizen  residents  in  New  York 
City  (Class  III),  and  1,026  alien  and  non-resident  patients  (Summary  C). 

These  1,026  alien  and  non-resident  patients  were  tabulated  according 
to  the  length  of  their  stay  in  New  York  State.  This  tabulation  appears  in 
Table  XL.  In  this  table  four  groups  are  made  of  these  1,026  patients,  as 
follows : 

Patients  who  had  been  in  the  State  of  New  York  less  than  2  months 
(which  practically  approximates  the  period  within  which  dependents 
are  "State  Poor"),  154;  who  were  maintained  1,627  days  in  the  Hospital, 
at  an  expense  of  $2,944.87.  These  154  patients  were  16.1  per  cent,  of 
the  1,026  aliens  and  non-residents  of  the  City. 

Patients  in  New  York  State  for  as  long  as  2  months  and  less  than 
I  year,  168;  who  remained  in  the  Hospital  1,954  hospital  days,  up  to  Sep- 
tember 9,  191 3,  at  an  expense  of  $3,536.74. 

Patients  whose  length  of  stay  in  the  State  could  not  be  positively 


150  HOSPITAL   COMMITTEE 

slated,  71.  Almost  all  of  these  patients  were  suffering  from  some  men- 
tal disability  or  weakness,  consequently,  information  as  to  their  residence 
in  the  State  was  lacking.  They  remained  in  the  Hospital  401  days,  at  a 
total  expense  of  $725.81. 

Patients  over  i  year  in  New  York  State,  633  cases.  Of  these,  594 
were  aliens  who  had  been  in  New  York  City  over  a  year,  and  39  were 
non-residents  of  the  City. 

If  the  proportion  of  patients  in  the  State  of  New  York  less  than  2 
months  to  the  total  1,026  cases  classified  be  extended  to  cover  the  71  pa- 
tients whose  residence  was  unknown,  and  22.5  per  cent,  be  added  for  a  pro- 
portion to  represent  the  patients  in  the  31  days  whose  histories  were  not  com- 
pleted, the  total  expense  to  the  City  of  maintaining  patients  admitted  in 
this  month  who  had  been  less  than  2  months  in  New  York  State  would 
have  been  $3,692.83.  On  this  basis  the  maintenance  of  this  class  for  a 
year  would  be  $44,313.96,  and  the  number  of  such  patients  would  be  2,367. 

It  is  recognized  that  there  is  I  day's  difference  between  the  Co  days 
maximum  residence  for  patients  defined  as  "State  Poor"  and  the  2  months 
used  in  the  foregoing  classification,  but  it  is  considered  no  exaggeration  to 
say  that  the  State  Poor  maintained  in  Bellevue  Hospital  would  cost  the 
City  this  much  a  year,  as  there  is  a  certain  proportion  of  patients  who 
may  have  been  in  New  York  State  more  than  2  months,  but  who,  never- 
theless, have  not  resided  in  any  county  of  the  State  for  the  period  of  60 
days,  and  are,  therefore,  State  Poor  by  the  definition  of  the  law. 

By  an  extension  of  the  proportion  of  the  total  patients  in  New  York 
State  less  than  i  year,  which  included  those  in  the  State  less  than  2  months, 
and  also  those  over  2  months,  to  cover  the  71  cases  whose  residence  in  the 
State  was  not  clearly  established,  and  the  same  proportion  among  the  pa- 
tients with  incomplete  histories  as  existed  among  those  classified  in  Table 
XXXVIII,  it  is  estimated  that  the  total  expense  to  the  City  of  maintaining 
patients  who  were  non-residents  of  the  State  admitted  to  Bellevue  Hospital 
during  these  31  days,  from  the  date  of  the  admission  of  each  to  September 
9,  1913,  amounted  to  $8,148.91.  On  this  basis  the  expense  for  a  year 
would  be  $97,786.92,  exclusive  of  the  expense  connected  with  grounds, 
buildings,  and  equipment,  and  there  would  be  5,086  admissions  of  such 
patients. 

It  is  also  interesting  to  notice  in  this  table  (Table  XL)  that  about  one- 
half  of  the  patients  in  the  State  less  than  2  months,  or  yy  cases,  were  de- 
portable aliens,  whose  expense  approximated  one-half  the  total  expense  of 
all  patients  falling  in  this  class.  Also,  it  is  important  to  observe  that  a 
substantial  majority  of  the  patients  in  the  State  less  than  i  year  were 
aliens,  and  that  about  40  per  cent,  of  the  patients  in  the  State  less  than  a 
year  were  deportable  aliens. 

Non-Residents  of  New  York  City 

While  the  City  of  New  York  is  indirectly  affected  by  the  burdens  of 
the  State,  nevertheless  the  problem  with  which  the  municipal  authorities 
have  to  deal  is  a  local  one.  Consequently,  it  is  of  prime  importance  for  the 
City  to  know  what  dependents  that  it  is  maintaining  have  gained  a  legal 
settlement  in  the  City  by  residing  here  i  year  as  required  by  law.  Ac- 
cordingly, the  1,026  alien  and  non-resident  patients  found  to  have  been 
admitted  to  Bellevue  Hospital  in  the  period  of  31  days  covered  by  the 


ALIENS  AND   NON-RESIDENTS  151 

examination  were  tabulated  according  to  their  length  of  stay  in  New  York 
City  (Table  XLI).  There  were,  as  may  be  seen  in  this  table,  361  pa- 
tients admitted  in  this  period  who  had  lived  less  than  i  year  in  New  York 
City,  who  had  remained  in  the  Hospital  4,017  days,  up  to  September  9,  at 
an  expense  of  $7,270.77. 

There  were,  however,  71  cases  whose  length  of  stay  in  New  York 
City  could  not  be  positively  given.  If  the  proportion  of  patients  in  the 
City  less  than  i  year  to  the  955  cases  classified  for  State  residence  be  ex- 
tended to  cover  these  71  cases,  and  22.5  per  cent,  added  to  include  the 
proper  proportion  of  the  incomplete  histories,  the  number  of  patients  with 
less  than  i  year's  residence  in  the  City  admitted  for  a  year  would  be  5,568, 
and  their  expense  $112,074.12.  Of  these  cases,  3,156  would  be  aliens,  main- 
tained at  an  expense  of  $61,041.84,  and  2,412  citizen  non-residents  of  the 
City,  at  an  expense  of  $51,032.28.  For  these  patients  admitted  during  the 
period  of  31  days  there  was  received  only  the  sum  of  $187  prior  to  Septem- 
ber I,  1913. 

Of  these  361  cases  in  the  City  less  than  i  year,  36  aliens  and  non-resi- 
dents, or  10  per  cent.,  had  been  in  the  City  less  than  i  day;  68,  or  18.8  per 
cent.,  had  been  in  the  City  less  than  3  days ;  86,  or  23.8  per  cent.,  less  than 
I  week;  137,  or  37.9  per  cent.,  less  than  i  month;  168,  or  46.5  per  cent., 
less  than  2  months ;  and  268,  or  74.2  per  cent.,  less  than  6  months.  Of  the 
955  alien  and  non-resident  patients  that  could  be  classified  according  to 
their  length  of  stay  in  the  City,  37.9  per  cent,  had  been  in  the  City  less  than 
I  year;  28.2  per  cent,  less  than  6  months;  17.7  per  cent,  less  than  2  months; 
14.4  per  cent,  less  than  i  month;  9.1  per  cent,  less  than  a  week;  7.2  per 
cent,  less  than  3  days;  and  3.8  per  cent,  less  than  i  day. 

Of  the  361  non-residents  of  the  City  admitted  in  31  days,  197  were 
aliens  (including  128  deportable  aliens),  as  compared  with  164  non-resident 
citizens.  According  to  this  showing,  in  a  year  there  would  be  3,156  aHen 
non-residents  of  the  City  maintained  at  public  expense  in  this  institution, 
out  of  which  2,244  would  be  deportable  from  the  United  States.  The  esti- 
mated expense  of  the  alien  non-residents  admitted  during  the  31  days  was 
$5,086.82,  of  which  amount  $3,075.63  was  incurred  for  the  maintenance  of 
deportable  aliens.  For  the  period  of  a  year  this  expense  would  be,  in 
proportion,  $61,041.84  for  the  hospital  care  of  alien  non-residents  of  the 
City,  exclusive  of  the  cost  of  grounds,  buildings,  and  equipment,  including 
$32,644.56  for  the  maintenance  of  aliens  who  could  be  deported  under  the 
Federal  or  State  laws. 


ALIENS,  NON-RESroENTS,  AND  STATE  POOR  IN  THE  DEPART- 
MENT OF  PUBLIC  CHARITIES 

The  situation  in  the  Department  of  Public  Charities  is  considerably 
clearer  than  in  the  Department  of  Bellevue  and  Allied  Hospitals;  for 
under  the  Charter  of  New  York  City,  as  already  quoted  in  this  Report, 
the  specific  statement  is  made  that  the  Commissioner  of  Public  Charities 
is  the  Overseer  of  the  Poor  of  New  York  City,  while  such  statement 
is  lacking  in  the  case  of  the  Board  of  Trustees  of  Bellevue  and  Allied 
Hospitals. 

The  Commissioner  of  Public  Charities  as  Overseer  of  the  Poor  is  in- 
trusted with  the  care  of  all  public  charges  as  poor  persons  in  all  insti- 
tutions within  the  City,  outside  of  the  Departments  of  Health  and  Belle- 
vue and  Allied  Hospitals.  This  Commissioner  is,  furthermore,  empowered 
and  required  to  investigate  the  propriety  of  the  relief  of  applicants  by  the 
City.  Also,  as  Overseer  of  the  Poor  he  is  authorized  to  cause  all  State  Poor 
persons  to  be  conveyed,  upon  warrant  issued  by  him,  to  the  State  Alms- 
houses, there  to  be  maintained  for  a  stipulated  weekly  rate,  to  be  paid  by  the 
State  Board  of  Charities.  Furthermore,  as  Overseer  of  the  Poor  he  is 
empowered  to  make  demands  upon  the  superintendents  or  overseers  of  the 
poor  in  other  towns  and  counties  for  the  maintenance  of  public  charges 
in  New  York  City  who  have  had  a  settlement  in  those  localities  and  are 
properly  chargeable  to  them. 

From  the  records  of  the  Department  of  Public  Charities  it  appears 
that  there  have  been  many  thousands  of  aliens  dependent  in  its  institutions, 
and  as  public  charges  in  the  private  institutions.  No  examination  in  this  con- 
nection was  made  of  any  institutions  in  this  Department  other  than  the 
examination  of  the  almshouses  hereafter  covered  in  this  Report  and  in  the 
report  of  this  Committee  on  "Admissions  to  City  Hom^s,"  but  the  following 
general  data  was  thought  to  be  important. 

A  great  disparity  existed  between  the  number  of  cases  that  could 
have  been  deported  from  Metropolitan  Hospital  in  the  year  191 1  and 
those  that  actually  were  deported,  according  to  the  table  of  deportation 
cases  compiled  from  the  Annual  Report  of  the  Department  of  Public 
Charities  for  that  year,  to  be  found  as  Table  LIV.  According  to  the 
figi.ires  from  the  Hospital  there  were  1,584  deportation  cases  of 
patients  in  the  institution  in  this  year,  of  which  number  only  269  were 
deported,  while  1,073  cases  left  the  institution  by  the  ordinary  method 
of  discharge.  If  we  exclude  from  the  total  number  of  deportation  cases 
in  this  institution  during  this  year  the  92  patients  who  died,  there  were  de- 
ported only  18  per  cent,  of  the  deportable  patients.  The  number  of  deporta- 
tion cases  discharged  was  four  times  as  large  as  the  number  removed. 

The  Brooklyn  Bureau  of  Dependent  Adults,  according  to  its  section 
of  the  Annual  Reports  of  the  Department  of  Public  Charities  for  the 
years  from  1906  to  191 1,  notified  the  State  Board  of  Charities  of  the 
dependence  of  961  public  charges  of  whom  this  Bureau  desired  the  City 
to  be  relieved.     However,  according  to  this  Bureau,  only  41  per  cent,  of 

152 


ALIENS  AND   NON-RESIDENTS  153 

the  cases  reported  in  these  years  were  taken  away  by  the  State  iioard. 
(Table  LV.) 

The  first  record  of  any  payments  made  by  the  Federal  Government 
to  the  Department  of  Public  Charities  occurs  in  the  Annual  Report  of  the 
Department  for  the  year  1910,  where  there  is  a  statement  of  the  receipt 
of  $5,662.83  for  the  maintenance  of  aliens.  In  the  year  191 1  a  similar 
record  is  made  of  the  receipt  of  $9,286.57.  These  payments  were  made  to 
the  Department  by  checks  from  the  State  Board  of  Charities.  The  Gov- 
ernment has  refused  to  make  any  payment  for  deportable  aliens  who  have 
been  held  in  an  institution  of  the  Department  of  Public  Charities  and 
have  died  there. 

During  the  year  between  July  i,  191 1,  and  June  30,  1912,  the  Brooklyn 
Bureau  of  Dependent  Adults  referred  105  cases  of  supposed  non-resident 
and  alien  poor  to  the  State  Board  of  Charities.  The  monthly  reports 
of  this  Board  show  only  20  of  these  cases  to  have  been  removed  from  the 
institutions  of  that  borough. 

The  85  cases  that  were  not  removed  from  these  institutions,  according 
to  the  records  kept  in  the  Bureau,  consisted  of  25  non-residents  and  60 
aliens.  Among  the  105  cases  reported  were  5  entered  upon  the  records  of 
the  Bureau  as  State  Poor.  This  Bureau  has  no  knowledge  of  payments 
that  are  made  for  aliens  and  State  Poor  maintained  within  this  district, 
as  all  such  payments  are  received  in  the  Commissioner's  office  in  Man- 
hattan. A  considerable  proportion  of  these  Brooklyn  cases  were  looked 
up  in  the  records  of  payments  made  by  the  State  Board  of  Charities, 
both  for  aliens  and  for  State  Poor,  but  no  evidence  could  be  found 
that  any  payments  had  been  received  for  any  of  them. 

The  Bureau  of  Dependent  Adults  in  Richmond  had  applications,  princi- 
pally for  hospital  care,  of  quite  a  number  of  alien  dependents.  Some 
of  these  were  reported  by  the  Bureau  to  the  State  Board  of  Charities, 
but  the  Bureau  had  no  knowledge  as  to  what  action  was  taken. 

The  State  Board  of  Charities  not  only  removes  aliens  from  public 
institutions,  but  also  removes  from  private  institutions  dependents  referred 
to  the  City  for  acceptance  as  public  charges.  In  the  file  of  cases  at  the 
Manhattan  Bureau  of  Dependent  Adults  there  were  843  names  of  alleged 
aliens  and  non-residents  that  had  been  reported  to  the  State  Board  of 
Charities  in  the  first  6  months  of  1912  for  investigation  and  possible 
removal  from  public  and  private  institutions  in  the  City.  During  the  same 
period  the  State  Board  of  Charities  and  the  United  States  Immigration 
Service  removed  from  these  institutions  only  504  dependents,  less  than 
two-thirds  as  many  as  had  been  reported. 

The  work  of  the  Department  of  State  and  Alien  Poor  of  the  State 
Board  of  Charities  in  New  York  City  for  the  fiscal  year  ending  Septem- 
ber 30,  1912,  will  be  found  in  Table  XLIV.  This  table  was  compiled 
from  the  monthly  reports  of  this  Department  of  its  removals  of  aliens 
and  non-residents  from  the  City,  and  also  of  the  removals  of  aliens  by 
the  United  States  Immigration  Service  that  had  been  reported  by  the 
State  Board.  There  were  1,353  removals  made  from  Greater  New  York 
in  this  year,  of  which  number  the  State  Board  made  1,309  and  the 
United  States  officials  only  44.  As  the  removals  by  the  latter  body  were 
of  aliens  only,  and  as  the  State  Board  removed  688  individuals  to  other 
countries,  according  to  its  reports,  it  would  appear  that  the  United  States 
Immigration  Service  made  only  6  per  cent,  of  the  removals  of  aliens,  while 
the  State  Board  made  94  per  cent. 


154  HOSPITAL   COMMITTEE 

If  the  Superintendent  of  State  and  Alien  Poor  has  continued  the 
practice  reported  by  him  for  191 1  (page  124  of  this  Report)  of  customarily- 
reporting  all  aliens  found  by  the  State  Board  in  public  institutions  to  the 
United  States  Commissioner  of  Immigration,  it  would  appear  that  this 
has  been  a  comparatively  fruitless  task. 

Of  the  1,353  removals,  877  were  from  the  Department  of  Public 
Charities,  of  which,  811,  or  92  per  cent,  of  the  total  from  this  Department, 
were  from  four  Manhattan  institutions.  In  addition  to  these  there  were 
183  cases  removed  from  various  private  institutions.  The  majority  of 
these  cases  presumably  had  been  referred  to  the  Department  of  Public 
Charities  by  the  private  institutions  as  charges  for  whose  maintenance 
and  care  the  City  should  pay. 

Of  the  877  removals  from  the  Department  of  Charities  464,  or  over 
50  per  cent.,  were  sent  to  other  countries,  while  128,  or  nearly  60  per  cent, 
of  those  removed  from  private  institutions,  and  all  of  those  from  the 
Department  of  Health,  and  from  the  State  institutions,  were  for  deporta- 
tion. 


Aliens,  Non-Residents,  and  State  Poor  in  Municipal  Almshouses 

Aliens 

An  examination  was  made  of  the  New  York  City  Home  for  the  Aged 
and  Infirm  located  on  Blackwell's  Island  to  ascertain  what  inmates  within 
the  institution  were  aliens,  non-residents,  and  State  Poor.  The  Home  is  a 
State  Almshouse  for  the' reception  of  State  Poor  by  virtue  of  a  contract 
between  the  State  and  the  City  authorities  in  accordance  with  the  law. 

This  examination  took  place  on  December  9,  1912,  and  all  names  of 
dependents  appearing  upon  the  registers  as  inmates  of  the  institution  were 
taken  into  account.  Of  these,  1,656  were  entered  upon  the  records  as  citi- 
zens, while  442  were  entered  as  aliens.  In  the  case  of  the  remainder  of 
the  dependents  the  records  did  not  show  whether  they  were  citizens  or 
aliens.  The  442  alien  dependents,  which  were  21.5  per  cent,  of  all  inmates 
that  could  be  classified,  were  supported  in  this  institution  at  an  expense 
of  $128.71  per  day  for  their  local  maintenance  only,  exclusive  of  all  general, 
administrative,  transportation,  and  other  charges  of  a  general  or  permanent 
nature. 

Accepting  the  proportion  of  aliens  to  citizens  as  an  average  proportion, 
and  estimating  the  daily  average  census  of  dependents  in  this  institution  for 
the  year  1912  to  have  been  2,583,  the  estimated  daily  average  of  aliens  in 
this  institution  in  this  year  would  have  been  555.  The  estimated  expense  for 
maintenance  of  these  aliens  in  this  institution  for  this  one  year  would  have 
been  $64,300,  exclusive  of  all  overhead  or  corporate  stock  expenses.  The 
overhead  charges  in  the  Department,  if  reckoned  against  the  institutions, 
would  raise  their  per  capita  expense  about  30  per  cent.  The  cost  of  the 
maintenance  of  these  aliens,  then,  approximated  $83,500,  excluding  charges 
for  permanent  investments. 

On  the  basis  of  the  proportion  of  aliens  to  citizens  found  in  this  Home 
there  would  have  been  an  average  of  281  aliens  daily  in  the  Brooklyn  City 
Home,  maintained  at  an  annual  expense  for  the  year  1912  of  $33,400,  ex- 
cluding the  charges  of  a  permanent  character.  Also,  there  would  have 
been  an  average  daily  number  of  215  at  Farm  Colony,  costing  the  City  for 
the  year  1912  $34,800  for  local  current  expense  only,  or  $45,200  exclusive 
of  corporate  stock  expense.  The  total  estimated  average  number  of  aliens 
in  the  City's  almshouses  for  this  year  would  have  been  1,051,  main- 
tained by  the  City  at  an  expense  of  $132,500,  exclusive  of  all  overhead  or 
carrying  charges;  or  $172,000  inclusive  of  overhead  charges  but  exclusive 
of  the  carrying  charges. 

It  would  be  necessary  to  remove  all  aliens  from  the  almshouses  in  order 
to  save  yearly  the  above  indicated  amount  of  $172,000.  Though  the  State 
Board  of  Charities  has  the  power  to  make  such  removals,  in  some  cases  it 
might  not  be  considered  advisable  to  remove ;  especially  where  a  dependent 
had  lived  for  many  years  in  this  City,  though  not  having  become  a  citizen 
of  the  United  States.  The  State  may  deport  an  alien  regardless  of  the 
length  of  time  that  he  may  have  resided  in  the  State.  If  we  assume  that 
it  is  reasonable  to  deport  an  alien  having  become  dependent  within  a  period 
of  5  years  from  the  time  of  his  arrival,  or  a  dependent  that  has  been  in 

155 


156  HOSPITAL   COMMITTEE 

the  country  over  5  years  but  whose  near  relatives  are  not  in  this  country, 
under  such  practice,  a  large  proportion  of  the  above  indicated  number  of 
aliens — 1.051 — would  be  deported.  Even  with  a  liberal  interpretation  of  the 
time  within  which  it  would  be  just  to  deport  an  alien,  the  City  would  save 
many  thousands  of  dollars  annually  if  the  State  Board  of  Charities  should 
exercise  its  power  of  removal  within  reasonable  time  limitations. 

Recent  admissions  to  the  almshouse  on  Blackwell's  Island  have  shown 
a  higher  percentage  of  aliens  among  them  than  was  found  among  the  in- 
mates in  the  institution  on  December  9,  1912.  In  the  Report  of  this  Commit- 
tee on  "Admissions  to  City  Homes"  are  gi\'en  the  proportions  of  aliens 
among  the  male  admissions  to  this  Home  that  could  be  classified,  in  Decem- 
ber, 191 1,  and  in  May,  1912.  From  the  investigation  made  in  this  study 
it  was  ascertained  that  43.6  per  cent,  of  the  admissions  that  could  be  classi- 
fied in  December,  191 1,  and  30.2  per  cent,  of  the  admissions  in  May,  1912, 
or  a  mean  of  34.8  per  cent,  for  the  2  months  were  of  aliens. 

In  the  Annual  Reports  of  the  Department  of  Public  Charities  from  1908 
to  191 1,  inclusive,  statements  were  made  that  the  Bureau  of  Dependent 
Adults  in  Manhattan  committed  yearly  from  1,200  to  1,500  aliens  to  this 
Home,  exclusive  of  the  State  Poor  committed  to  the  same  institution. 
(Table  XLV.) 

Non-Residents 

The  examination  made  of  the  Manhattan  City  Home  did  not  disclose 
more  than  23  dependents  entered  upon  the  register  as  non-residents  of  New 
York  State  remaining  in  the  Home  on  December  9,  1912.  No  information 
was  available  as  to  how  many  of  the  inmates  were  non-residents  of  this  City. 
Six  per  cent,  of  the  male  admissions  in  December,  191 1,  and  May,  1912,  were 
definitely  ascertained  to  have  been  non-residents  of  the  City.  It  seems  inad- 
visable to  attempt  to  estimate  the  number  of  non-residents  in  almshouses  on 
such  meagre  data. 

State  Poor 

On  June  20,  1875,  the  State  Board  of  Charities  made  a  contract  with  the 
authorities  at  that  time  in  charge  of  the  poor  relief  in  the  County  of 
Kings.  The  State  Board,  in  accordance  with  Article  7,  Sec.  90,  of  the 
Poor  Law,  designated  the  Kings  County  Almshouse,  now  known  as  the 
New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division,  as  a 
State  Almshouse,  and  agreed  to  pay  the  authorities  in  charge  of  this  Alms- 
house for  the  State  Poor  persons  committed  to  and  maintained  by  them 
at  the  rate  of  $2.50  a  week.  A  similar  contract  was  entered  into  with  the 
Department  of  Public  Charities  on  Feb.  28,  1902,  when  the  New  York 
County  Almshouse,  on  Blackwell's  Island,  now  known  as  the  New  York 
City  Home  for  the  Aged  and  Infirm,  Manhattan  Division,  was  also  desig- 
nated as  a  State  Almshouse,  and  the  State  agreed  to  pay  $2.50  a  week  for  the 
maintenance  of  State  Poor  at  this  institution  also.  After  the  contract  was 
entered  into  by  which  the  latter  Home  became  a  State  Almshouse,  the  num- 
ber of  State  Poor  committed  and  the  number  supported  annually  in  the 
Brooklyn  City  Home  was  reduced  to  about  10  per  cent.,  and  less,  of 
the  number  committed  and  maintained  in  1902  in  this  institution.  For 
example,  there  were  committed  in  1902,  681  State  Poor,  and  the  whole 
number  supported  in  that  year  was  710,  whereas  in  the  year  1903  there 
were  only  66  committed  and  72  maintained  in  the  same  Home.  This  de- 
crease was  more  marked  in  subsequent  years.     As  will  be  seen  in  Table 


ALIENS  AND   NON-RESIDENTS  157 

XLVI,  the  number  committed  in  1904  was  only  40;  in  1905,  48;  in  1906, 
47.  There  was  a  slight  increase  in  1907  to  56  State  Poor  committed  to  this 
Home.  This  was  followed  in  1908  by  a  marked  reduction  to  only  20 
cases.  The  figures  for  the  1909  commitments  to  this  Home  do  not  appear 
in  the  Annual  Report  of  the  State  Board  of  Charities  for  that  year,  but 
in  1910  there  were  only  44  committed,  and  in  191 1  only  20.  Similarly,  the 
total  number  of  those  supported  diminished,  as  will  be  seen  from  the  same 
table.  The  first  2  years  of  this  lo-year  period  were  marked  by  the  commit- 
ment of  a  large  number  of  State  Poor  to  the  Manhattan  City  Home. 
There  were  634  committed  in  1902  and  933  in  1903.  In  1904,  however,  the 
number  committed  dropped  to  532,  and  the  following  year  to  126;  after  that 
it  did  not  exceed  234  in  any  one  year  of  this  lo-year  period. 

The  marked  decrease  in  the  number  of  State  Poor  reported  and  main- 
tained by  the  State  in  the  State  at  large  has  been  commented  upon  in  the 
opening  section  of  this  Report  dealing  with  the  State  Poor,  and  an  explana- 
tion will  be  found  there  in  which  the  State  Board  attributes  this  falling  off 
to  their  more  rigid  examinations  of  alleged  State  Poor  and  speedier 
removals. 

It  is  remarkable  that,  while  from  1902  to  191 1  the  burden  of  the  City  had 
increased  steadily,  the  payments  by  the  State  for  the  maintenance  of  State 
Poor  in  two  of  the  City's  almshouses  decreased.  In  the  year  1902,  accord- 
ing to  the  records  of  the  Department  of  Public  Charities,  that  Depart- 
ment received  $5,516.44  for  the  maintenance  of  State  Poor  in  New  York 
City,  whereas  the  sum  paid  for  this  maintenance  in  1912  was  only  $606.79 
Nor  was  this  diminution  in  the  payment  from  the  State  to  the  City  for 
such  charges  made  up  for  by  any  corresponding  increase  in  the  expense 
incurred  by  the  State  in  removing  these  State  Poor  cases  from  New  York 
State.  On  the  contrary,  it  was  found  that,  whereas  in  1902  there  was 
$9,062.54  spent  in  such  removals,  this  expenditure  had  decreased  to 
$1)595-36  in  1909,  and  to  $2,816.36  in  191 1.  Again,  the  proportion  New 
York  City  received  out  of  the  entire  funds  paid  to  New  York  State 
decreased  from  43  per  cent,  in  1902  to  as  low  as  10  per  cent,  in  1906,  and 
although  there  were  variations  in  the  percentage  received  by  the  City 
during  the  next  4  years,  at  no  time  did  it  exceed  the  18  per  cent,  paid  to 
the  City  in  1910.  In  191 1,  the  last  year  for  which  information  was  avail- 
able, only  14  per  cent,  of  the  total  expense  of  maintenance  paid  by  the 
State  was  paid  to  New  York  City.  In  figuring  these  percentages  atten- 
tion is  called  to  the  fact  that  the  year  represented  in  the  Annual  Report 
of  the  Department  of  Public  Charities  does  not  correspond  exactly  to  the 
year  of  the  Reports  of  the  State  Board  of  Charities,  the  fiscal  year  in 
the  latter  ending  September  30,  and  of  the  former  December  31.  This, 
however,  does  not  affect  the  fact  that  there  has  been  a  very  marked 
decline  in  the  proportion  of  the  maintenance  of  State  Poor  paid  to  New 
York  City.     (Table  XLVII.) 

The  removals  of  the  State  Poor  by  the  State  Board  of  Charities  from 
New  York  City  formerly  constituted  a  large  majority  of  the  removals 
from  the  entire  State,  including  the  City.  For  example,  in  the  year 
1902,  and  also  in  1903,  82  per  cent,  of  the  removals  of  State  Poor  from 
the  entire  State  were  from  the  two  City  Homes  of  New  York  City. 
In  the  year  191 1  this  proportion  was  just  one-half,  or  41  per  cent. 
(Table  XLVIII.) 

The  decision  as  to  who  should  be  considered  a  State  Poor  person  and 
who  should  not  would  seem  to  be  made  by  the  State  Board  of  Charities 


158  HOSPITAL   COMMITTEE 

alone.  The  basis  of  their  decision  would  seem  to  have  been  set  forth  in 
the  report  of  the  Committee  on  State  and  Alien  Poor  for  the  year  ending 
September  30,  1904,  in  Vol.  I  of  the  Report  of  the  State  Board  of  Chari- 
ties for  that  year,  as  follows : 

The  test  of  more  than  sixty  days'  residence  in  a  county  has  not  been  qualified 
in  the  law  by  any  condition.  It  rests  upon  the  presence  of  the  person  within  the 
county  Hmits  for  more  or  less  than  sixty  days.  It  docs  not  matter  what  the  per- 
son has  been  doing  during  the  period,  or  what  his  condition  has  been  if  he  has  not 
within  the  time  made  application  for  relief  to  a  public  officer  authorized  to  dis- 
pense the  same.  The  liability  of  the  State,  county  or  town  is  settled  by  the  actual 
presence  of  the  person  within  a  county  for  the  prescribed  period  of  time. 

The  law  now  depends  upon  no  individual's  judgment.  It  specifically  sets  forth 
the  qualifications  of  a  State  poor  person,  and  for  this  reason  all  persons  who  come 
under  its  provisions  must  receive  the  same  consideration,  irrespective  of  the  tem- 
peraments of  administrative  officers.  All  counties  are  treated  alike,  for  to  all  cases 
the  one  standard  is  applied. 

In  spite  of  the  clear-cut  definition  given  in  these  extracts  from  this 
report  there  has  been  wide  variance  apparent  between  the  opinion  of 
the  Bureau  of  Dependent  Adults,  Manhattan,  of  the  Department  of  Public 
Charities,  and  the  opinion  of  the  Department  of  State  and  Alien  Poor  of 
the  State  Board  of  Charities  as  to  who  have  been  State  Poor.  For 
example,  it  is  shown  in  Table  XLIX  that,  according  to  the  State  Board 
of  Charities,  in  the  period  of  10  years  from  1902  to  191 1  there  were  (omit- 
ting the  year  1909,  for  which  the  State  Board  did  not  publish  the  figures  on 
this  point)  3,161  State  Poor  committed  to  the  Manhattan  City  Home, 
whereas  for  the  same  years,  according  to  the  reports  of  the  Bureau  of 
Dependent  Adults,  Manhattan,  there  were  6,185  State  Poor  committed  to 
this  same  institution.  From  these  figures  it  would  seem  that  only  a  little 
over  one-half  of  those  that  the  Bureau  of  Dependent  Adults  classed  as 
State  Poor  among  the  commitments  to  this  one  institution  were  so  recog- 
nized by  the  State  Board  of  Charities. 

There  is  kept  at  the  Manhattan  City  Home,  which  is  a  State  Alms- 
house, what  is  called  a  "State  Register"  in  which  the  names  of  those 
public  charges  that  are  classed  as  State  Poor  are  entered.  During  the 
year  ending  September  30,  1912,  there  were  181  such  persons  entered 
upon  this  book.  The  disposition  of  these  alleged  State  Poor  as  entered 
upon  this  same  Register  is  given  in  Table  L.  There  were  51  out  of  this 
total  of  181,  or  28  per  cent.,  discharged  as  not  proper  State  cases.  As  a  result 
of  the  large  discrepancy  between  the  reports  of  the  Bureau  of  Dependent 
Adults  and  of  the  State  Board  of  Charities  as  to  the  number  of  State  Poor 
maintained  in  this  institution,  there  was  also  a  great  discrepancy  in  the  return 
made  to  the  City  for  the  number  of  State  Poor  accepted  as  State  charges 
and  maintained  in  this  institution,  and  the  amount  it  is  estimated  might 
have  been  due  the  City  if  the  State  had  accepted  all  cases  classed  as  State 
Poor  by  the  Bureau.  In  Table  LI  there  is  an  estimate  of  the  expense 
of  the  State  Poor  maintained,  based  on  the  number  reported  to  have 
been  in  the  institution  by  the  Bureau  of  Dependent  Adults.  The  average 
per  capita  per  diem  expense  for  these  dependents  to  the  City  was  ascertained 
from  the  Annual  Reports  of  the  Department  of  Public  Charities.  The 
average  days  stay  for  the  dependents  termed  State  Poor  by  the  De- 
partment of  Charities  is  not  known.  The  average  of  the  stay  of  the 
inmates  in  this  almshouse  on  a  certain  day  was  found  to  be  1,004  days, 
but    this    number    was    not    accepted    as  the  average  stay  in  making  this 


ALIENS  AND   NON-RESIDENTS  1 59 

estimate.  Instead,  the  very  low  average  stay  found  in  the  State  Board 
of  Charities'  Annual  Reports  from  the  number  maintained,  and  the  amount 
paid  during  the  year  for  this  number,  with  the  known  rate  of  $2.50 
per  week,  was  accepted.  This  number  varied  in  these  10  years  from 
a  minimum  of  8  days  in  191 1  to  a  maximum  of  18  days  in  1905.  The 
average  number  of  days  in  each  year  will  be  found  in  this  table.  This 
estimate  shows  that  there  was  a  net  loss  to  the  City  in  9  of  these  10 
years  of  $12,435.37.  The  year  1909  was  not  included  in  this  estimate, 
as  the  State  Board  did  not  publish  the  necessary  data  in  its  Annual 
Report  for  that  year.  The  total  payments  made  by  the  State  Board  of 
Charities  to  the  Department  of  Public  Charities  for  the  maintenance  of 
the  State  Poor  in  this  institution  for  these  years  was  $15,692.10.  It 
will  be  seen  from  this  table  that  the  ratio  of  the  estimated  amount  due 
to  the  City  for  the  State  Poor  maintained  according  to  the  Department 
of  Public  Charities  to  the  amount  paid  to  the  City  for  the  State  Poor 
maintained,  according  to  the  judgment  of  the  State  Board  of  Charities, 
was  73  to  100. 

The  State  Poor  entered  upon  the  "State  Register"  at  this  institution 
for  the  year  ended  September  30,  1912,  for  whom  bills  were  said  to  have 
been  rendered  to  the  State  Board  of  Charities  numbered  126.  As  shown 
in  Table  LII,  according  to  the  entries  in  this  book,  only  35  of  these  126 
cases,  or  28  per  cent.,  had  been  inmates  of  the  City  Home;  11  had  been 
in  the  Municipal  Lodging  House;  37  in  City  Hospital;  28  in  Metropolitan 
Hospital;  2  were  in  Bellevue  Hospital;  and  i  in  each  of  two  private 
institutions,  the  Misericordia  Hospital  and  the  Society  for  the  Prevention 
of  Cruelty  to  Children. 

In  view  of  the  very  large  decrease  in  the  number  of  State  Poor 
maintained  by  the  State  Board  of  Charities  at  this  institution  it  is  interesting 
to  notice  the  following  cases  that  were  admitted  to  this  institution  in  the 
month  of  December,  191 1.  During  this  period  there  came  to  this  Home  9 
cases  (among  the  males  only)  that  fell  within  the  class  of  State  Poor,  ac- 
cording to  the  law  placing  all  dependents  with  less  than  60  days  residence  in 
the  State  in  this  category.    Digests  of  these  cases  follow : 

Case  I.  A  native  of  Ireland,  35  years  of  age.  Eleven  days  in  the  United 
States  and  the  same  time  in  the  City.  This  dependent  was  reported  to  the  State 
Board  of  Charities  by  the  Bureau  of  Dependent  Adults  and  was  removed  from 
the  almshouse  by  the  State  Board  on  the  12th  day  of  his  stay  there.  He  was 
taken  to  City  Hospital  the  following  day,  and  removed  from  the  latter  institution 
on  the  2Sth  day  of  his  stay  there,  or  on  the  37th  day  of  his  stay  in  the  two  institu- 
tions, and  returned  to  Ireland  by  the  State  Board  of  Charities.  This  dependent  does 
not  appear  on  the  State  Register  as  a  State  Poor  case. 

Case  2.  A  native  of  the  United  States,  54  years  of  age.  Four  days  in  New 
York  State  according  to  the  City  Home  record.  This  case  was  reported  to  the 
State  Board  of  Charities  by  the  Bureau  of  Dependent  Adults  upon  the  date  of  his 
admission,  and  was  removed  by  the  State  Board  the  9th  day  of  his  stay  in  the 
Home  and  sent  to  Connecticut.  Although  this  case  came  within  the  cognizance  of 
the  State  Board  of  Charities  it  was  not  entered  upon  the  State  Register  as  a 
State  Poor  case. 

Case  3.  A  native  of  the  United  States.  28  years  of  age.  Two  days  in  New 
York  State  according  to  the  City  Home  record.  This  case  was  reported  to  the 
State  Board  of  Charities  by  the  Bureau  of  Dependent  Adults  upon  the  date  of 
admission,  and  was  removed  from  the  almshouse  by  the  State  Agent  on  the  nth 
day  of  his  stay  there  and  sent  to  Kentucky.     Although  this  case  came  under  the 


l6o  HOSPITAL   COMMITTEE 

cognizance  of   the   State  Board   of   Charities,  it  was   not  entered   upon  the   State 
Register  as  a   State   Poor  case. 

Case  4.  A  native  of  England,  24  j-ears  of  age.  Three  weeks  in  New  York 
State  according  to  the  City  Home  record.  This  case  was  reported  to  the  State 
Board  of  Charities  by  the  Bureau  of  Dependent  Adults,  and  was  removed  from 
the  almshouse  by  the  State  Board  on  tlic  6th  day  of  his  stay  there  and  sent  to 
Chicago.  This  dependent  had  previously  been  an  applicant  for  relief  from  a  private 
society.  Although  his  case  came  within  the  cognizance  of  the  State  Board  of 
Charities,  it  was  not  entered  upon  the  State  Register  as  a  State  Poor  case. 

Case  5.  A  native  of  Ireland,  21  years  of  age.  Six  weeks  in  the  United  States 
and  New  York  City  according  to  the  City  Home  record.  This  case  was  reported 
to  the  State  Board  of  Charities  by  the  Bureau  of  Dependent  Adults  on  the  date 
of  admission  to  the  almshouse,  and  was  removed  therefrom  on  the  40th  day  of  his 
stay  by  an  agent  of  the  Federal  Government  and  returned  to  Ireland.  Although  this 
case  came  within  the  cognizance  of  the  State  Board  of  Charities,  it  was  not  entered 
upon  the  State  Register  as  a  State  Poor  case. 

Case  6.  A  native  of  Germany,  65  years  of  age.  Six  weeks  in  the  United 
States  and  in  New  York  City  according  to  the  record  in  the  City  Home.  This 
dependent,  according  to  the  Home  records,  "eloped"  from  this  institution  on  the 
63rd  day  of  his  stay  there,  but  according  to  the  reports  of  the  State  Board 
of  Charities  he  was  removed  from  this  Almshouse  on  the  72nd  day  of  his  stay  there 
and  sent  to  Canada.  Although  this  case  came  within  the  cognizance  of  the  State 
Board  of  Charities  it  was  not  entered  upon  the  State  Register  as  a  State  Poor 
case. 

Case  7.  A  native  of  the  United  States,  67  years  of  age.  Five  days  in  New 
York  State  according  to  the  records  of  the  City  Home.  This  dependent  was  trans- 
ferred from  this  Home  to  Farm  Colony  on  the  63rd  day  of  his  stay  at  the  Home. 
He  absconded  from  the  latter  place  after  22  days,  or  on  the  85th  day  of  his  stay 
in  the  two  institutions.  This  case  was  not  entered  upon  the  State  Register  as  a 
State  Poor  case. 

Case  8.  A  native  of  Ireland,  68  years  of  age.  Four  days  in  New  York  State 
according  to  the  record  at  the  City  Home.  This  dependent  was  admitted  to  this  Home 
by  transfer  from  Bellevue  Hospital  after  a  stay  of  4  days.  He  was  discharged 
from  the  Home  upon  the  79th  day  of  his  stay  there.  His  name  was  not  entered 
upon  the  State  Register  as  a  State  Poor  case. 

Case  9.  A  native  of  the  United  States,  45  years  of  age.  Four  weeks  in  New 
York  State  according  to  the  records  of  the  City  Home.  This  case  was  entered  upon 
the  State  Register  after  admission.  He  was  removed  from  the  Home  on  the  gth 
day  of  his  stay  there  by  the  State  Board  of  Charities  and  sent  to  Illinois. 

Removals 

Among  the  dependents  in  the  Manhattan  City  Home  at  the  time  of 
the  examination,  December  9,  191 2,  there  were  found  290  ahens  and 
non-residents  that  had  been  admitted  in  the  years  191 1  and  1912  and 
were  still  remaining  there. 

During  the  first  half  of  the  year  1912  there  were  1,944  admissions  to 
the  Home.  H  the  proportion  of  aliens  among  these  is  the  same  as  the 
proportion  found  in  the  Home  December  9,  1912,  namely,  21.5  per  cent., 
there  must  have  been  418  aliens  admitted  to  the  Home  during  this  period. 
The  Annual  Reports  of  the  Department  of  Public  Charities  seem  to  in- 
dicate that  this  number  is  an  under-estimate,  as  they  show  that  between 
1,200  and  1,500  aliens  have  been  admitted  to  the  Home  annually  (Table 
XLV).  The  monthly  reports  of  the  State  Board  of  Charities  of  removals 
from  institutions  in  Greater  New  York  sho^v  only  80  dependents  to  have 
been  removed  from  this  institution  during  this  time. 


ALIENS  AND  NON-RESIDENTS  l6l 

An  examination  was  made  of  the  file  at  the  Manhattan  Bureau  of 
Dependent  Adults  of  the  alleged  aliens,  non-residents,  and  State  Poor 
that  were  reported  by  this  Bureau  to  the  State  Board  of  Charities  for 
investigation  for  removal  after  their  commitment  to  the  Manhattan  City 
Home.  There  were  133  such  cases  found  in  this  file.  Investigation  of 
the  records  at  the  Home  showed  that  these  cases  were  disposed  of  as 
listed  in  Table  LHI.  According  to  this  table  19  of  these  cases  were 
removed  for  deportation  to  other  countries  either  by  an  agent  of  the 
State  Board  or  of  the  United  States  Immigration  Service,  and  24  were 
removed  to  be  sent  to  other  states.  The  records  showed  that  39  were_  dis- 
charged to  the  State  Agent,  but  the  final  disposition  of  these  is  not  given. 
Of  these  133  cases,  15  were  discharged  from  this  institution  upon  the 
recommendation  of  the  Department  of  State  and  Alien  Poor  of  the  State 
Board  to  that  effect,  which  implies  that  this  Department  had  decided 
that  these  dependents  should  not  be  removed  at  State  expense;  and  11 
were  discharged  without  any  reason  being  entered.  Of  these  133  depend- 
ents, I  died  in  the  institution  and  19  of  them  could  not  be  found  entered 
upon  the  register  at  the  Home.  There  was  i  dependent  who,  according 
to  the  records  of  the  institution,  had  been  returned  to  the  ship.  This 
dependent  was  an  alien  who  had  been  only  8  days  in  the  United  States 
prior  to  his  admission  at  this  time  to  the  City  Home.  This  alien  was 
discharged  about  3  weeks  after  his  admission  to  the  Home,  and  but  12 
days  after  this  discharge  he  was  committed  to  City  Hospital  through  the 
Manhattan  Bureau  of  Dependent  Adults,  and,  according  to  the  records, 
the  Bureau  again  called  the  attention  of  the  State  Board  of  Charities 
to  the  dependence  of  this  alien  upon  the  City.  This  dependent,  however, 
left  the  Hospital  4  days  after  admission,  not  to  go  to  a  foreign  country, 
but,  according  to  the  records,  his  address  was  in  New  Jersey. 

Among  the  4  dependents  remaining  in  the  institution  in  1913  there 
was  I  that  had  been  admitted  in  July,  1912.  The  State  Board  of  Chari- 
ties had  recommended  that  this  dependent  be  discharged,  but  on  account 
of  lameness  he  was  allowed  to  remain  in  the  Home.  Another  of  these 
4  had  been  in  the  Home  for  3  weeks  prior  to  the  investigation  by  the  Com- 
mittee on  January  8,  1913.  Each  of  the  2  others  had  been  in  the  Home 
for  more  than  3  months. 

Although  65  per  cent,  of  the  admissions  to  the  Brooklyn  City  Home 
were  of  foreign  born  dependents,  as  compared  with  the  70  per  cent,  of 
those  to  the  Manhattan  City  Home,  according  to  their  reports  for  191 1 
very  few  removals  have  been  made  from  the  former  Home.  In  the  year 
ended  September  30,  1912,  the  State  Board  of  Charities  reported  only  8 
removals  from  the  Brooklyn  Home  by  its  agent  and  no  removals  by  the 
United  States  Immigration  Service.     (Table  XLIV.) 

The  third  almshouse.  Farm  Colony,  on  Staten  Island,  although  its  191 1 
proportion  of  foreign  born  among  its  admissions  was  63  per  cent.,  had 
no  removals  whatever  reported  by  the  State  Board  during  the  same 
year. 


l62 


HOSPITAL   COMMITTEE 


TABLE  I. 
Admissions  of  Foreign  Born  to  New  York  City  Municipal  Institutions  in  1911. 


Name  of  Institution 


Born  in 
United 
States 


Born  in 

Other 

Countries 


Percentage 

Bom  in 

Other 

Countries 


4,134 


34,531 


50,980 


34,531 
50,980 


85,511 


70.0 


DEPARTMENT   OF    PUBLIC    CHARITIES 

N.  Y.  Citv  Home  for  the  Aged  and 

Infirm,  Manhattan 1,221  2,913 

N.  Y.  Citv  Home  for  the  Aged  and 

Infirm,  Brooklyn 1,216  2,244 

N.  Y.  City  Farm  Colony 547  937 

Almshouse  Total 2,984  6,094 

N.  Y.  City  Children's  Hospitals. . .  Nativity  not 

Municipal  Lodging  House 95,395  72,020 

Metropolitan  Hospital 4,331  5,364 

City  Hospital 3,045  4,325 

Kings  Count V  Hospital 7,734  5,357 

Cumberland  Street  Hospital 2,070  706 

Bradford  Street  Hospital 60  28 

Reception  Hospital,  Coney  Island. .  990  521 

Hospital  Total 18,230  16,301 

BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 17,634  18,838 

Gouvemeur  Hospital 1,660  2,733 

Harlem  Hospital 3,450  2,359 

Pordham  Hospital 2,499  1,807 

25,243  25,737 

HOSPITALS  IN    BOTH    DEPARTMENTS 

Department  of  Public  Charities .  . .  18,230  16,301 

Bellevue  and  Allied  Hospitals 25,243  25,737 

Total  for  Hospitals  in  both  De- 
partments    43,473  42,038 


3,460 
1,484 

65.0 
63.0 

9,078 

67.0 

published 

167,415 

43.0 

9,695 
7,370 
13,091 
2,776 
88 
1,511 

55.0 
59.0 
40.0 
25.0 
32.0 
34.0 

47.0 


36,472 

52.0 

4,393 

62.0 

5,809 

40.0 

4,306 

42.0 

50.0 


47.0 
50.0 


ALIENS  AND   NON-RESIDENTS 
TABLE  II. 


163 


Comparison  of  Removals  of  Aliens  from  the  Entire  State  by  the  State  Board  of 

Charities  and  the  Return  of  Aliens  from  New  York  City 

BY  THE  Department  of  Public  Charities. 


Year 


■o  J  V  Transferred  from 

Stetre'Lard^of      N.  Y.  City  Only,  by 

Char'ftfes^from  °En-     p^^Rf™,! 

tire  State  (Includ-    ,^"^1"=   Chanties 

■,^r,-tT%-  nil^A       to  Commissioners 

mg  N.  Y.  City).        ^^  immigration 


1902. 
1903. 
1904. 
1905. 
1906. 
1907. 
1908. 
1909. 
1910. 
1911. 


81 

93 

47 

143 

276 

413 

761 

577 

738 

1,074 


1,137 

861 

328 

43 


4,203  2,369 

Yearly  Average 420  (10  years)  592  (4  years) 

I 

*  Transfers  by  the  Department  of  Charities  direct  to  the  Commissioners  of  Immigration 
were  discontinued  after  the  year  1905. 


TABLE   III. 

Total    Number    State   Poor    Committed    to    State    Almshouses    According   to 
Reports  of  the  State  Board  of  Charities. 


Year 


Number  of 
State  Poor 
Committed 


1874 563 

1875 654 

1876 633 

1877 872 

1878 1,120 

1879 1,587 

1880 1,343 

1881 1,373 

1882 1,392 

1883 1,426 

1884 1,892 

1885 1,848 

1886 1,606 

1887 1,617 

1888 1,665 

1889 1,757 

1890 1,440 

1891 1,365 

1892 1,367 


Number  of 
State  Poor 
Committed 


1893 1,406 

1894 1,974 

1895 2,171 

1896 2,102 

1897 1,987 

1898 1,804 

1899 2,049 

1900 1,872 

1901 1,685 

1902 1,727 

1903 1,436 

1904 971 

1905 543 

1906 521 

1907 632 

1908 651 

1909 569 

1910 ••....  514 

1911 ••....  592 


1 64 


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174  HOSPITAL   COMMITTEE 


TABLE   XIV. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  I.     Aliens  Whose  Admissions  Were  Authorized  by  Section  dgz,  Subd.  7,  of  the  City 
Charier. 


ss 


J=  o 


A.   Admission  ^"3     ^"3 

^;5 


pq  ^      O  ^        ^       OM 


m        m         ts     m^      &        f< 


1.  Apparently    improperly    admitted    to    the 

United  States 7  6     1  7        21 

2.  Apparently  deportable  by  the  United  States 

3.  Apparently  removable  by  State  Board  of 

Charities 23         12  3  1  1        40 

4.  Apparently  removable  by  State  Board  of 

Alienists 67         13        54        17     ....       151 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address ^ 6  4  2     12 

5b.  Apparently  covinty  or  town  cases  without 

N.  Y.  City  address _. 7  5     ....  1     ....         13 

5c.  Apparently  county  or  town  cases  giving  no 

address 4  1  1     6 

6.  State  Poor  (not  in  other  classes) 23        45     68 

7.  Apparently  charges  of  steamship  company 2     2 

8.  Without  settlement  in  the  United  States.  .  .         20         31  2  2     55 

9.  Without  settlement  in  N.  Y.  State 2  3  1     6 

10.  State  settlement  unknown 

11.  Claiming   N.   Y.    City   settlement   without 

N.  Y.  City  address 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 

13.  Apparently  justifiable  as  City  charges 17         12  2  1         14        46 

Total 176       134        65        23        22      420 


ALIENS  AND   NON-RESIDENTS 


175 


TABLE  XV. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  I.    Aliens  Whose  Admissions  Were  Authorized  by  Section  6g2,  Subd.  7,  of  the  City 

Charter. 


Removed  by 

•i 

t 

y^ 

"S  s 

1;^ 

;t 

B.   Disposition 

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o-'p 

n 

s 

H 

Si3 

•0 
Q 

00 

e2 

1. 

Apparently     improperly     ad- 

mitted to  the  United  States . 

17 

2 

2 

21 

2. 

Apparently  deportable  by  the 
United  States 

3. 

Apparently  removable  by  State 

21 

7 

7 

1 

1 

2 

1 

40 

4. 

Apparently  removable  by  State 

Board  of  Alienists 

30 

117 

1 

2 

1 

151 

5a. 

Apparently    county    or    town 
cases  with  N.  Y.  City  ad- 
dress   

12 

12 

5b. 

Apparently    county    or    town 
cases   without   N.   Y.   City 

address 

10 

1 

1 

1 

13 

5c. 

Apparently    county    or    town 

cases  giving  no  address.  .  .  . 

4 

1 

1 

ti 

6. 

State     Poor     (not     in     other 

^classes)  

56 

1 

11 

fiS 

7 

Apparently  charges  of  steam- 
ship company 

2 

2 

8. 

Without    settlement    in    the 

53 

2 

55 

9. 

Without  settlement  in  N.  Y. 

State 

6 

6 

10. 

State  settlement  unknown .... 

11. 

Claiming   N.   Y.    City   settle- 
ment  without   N.   Y.   City 
address 

12. 

Claiming   N.   Y.    City   settle- 
ment with  address  outside 
of  N.Y.  State 

13. 

Apparently  justifiable  as  City 

43 
254 

3 
132 

9 

5 

2 

17 

1 

46 

Total 

420 

176 


HOSPITAL   COMMITTEE 


TABLE  XVI. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Ye.\r  1912. 

Class  II.    Aliens  Whose  Admissions  Were  Not  Authorized  by  Section  6q2,  Subd.  7,  of  the 

City  Charter. 


A.  Admission 


m 


oe 
m 


^  S 
•a       50 

.S     o| 


a. 


1.  Apparently    improperly    admitted    to    the 

United  States 12  13  104  13          1  143 

2.  Apparently  deportable  by  the  United  States 

3.  Apparently  removable  by  State  Board  of 

Charities ' 17  23  158  24     ....  222 

4.  Apparently  removable  by  State  Board  of 

Alienists 3  4     7 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 5  ....  11     16 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 4  8          3     15 

5c.  Apparently  county  or  town  cases  giving  no 

address 1  13     14 

6.  State  Poor  (not  in  other  classes) 21  10  65          9     105 

7.  Apparently  charges  of  steamship  company 12  5  1          2  20 

8.  Without  settlement  in  the  United  States ...         81  34  136        27     278 

9.  Without  settlement  in  N.  Y.  State 5  3  25     33 

10.  State  settlement  unknown 8  4  45  5     ....  62, 

11.  Claiming   N.   Y.   City  settlement  without 

N.  Y.  City  address 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 7          1     8 

13.  Apparently  justifiable  as  City  charges 1  4  2  5 

Total 150  107  581  87          5  928 


ALIENS  AND   NON-RESIDENTS 


177 


TABLE  XVII. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  II.    Aliens  Whose  Admissions  Were  Not  Authorized  by  Section  6p2,  Subd.  7,  of  the 

City  Charter. 


B.   Disposition 


Removed  by 

n-l 

^ 

T) 

n1 

0 

m 

•c 

"^    M 

u 

a 

0 

^  S3 
■g"S 

^ 

m 

•*.! 
0 

t>W 

S 

^ 

1.  Apparently     improperly     ad- 

mitted to  the  United  States . 

2.  Apparently  deportable  by  the 

United  States 

3.  Apparently  removable  by  State 

Board  of  Charities 

4.  Apparently  removable  by  State 

Board  of  Alienists 

5a.  Apparently  county  or  town 
cases  with  N.  Y.  City  ad- 
dress   

5b.  Apparently  county  or  town 
cases  without  N.  Y.  City 
address 

5c.  Apparently  county  or  town 
cases  giving  no  address .... 

6.  State     Poor     (not    in     other 

classes) 

7.  Apparently  charges  of  steam- 

ship company 

8.  Without    settlement    in    the 

United  States 

9.  Without  settlement  in  N.  Y. 

State 

10.  State  settlement  unknown .... 

11.  Claiming   N.   Y.   City   settle- 

ment  without   N.   Y.   City 

12.  Claiming   N.   Y. '  City'  settle- 

ment with  address  outside 
of  N.  Y.  State 

13.  Apparently  justifiable  as  City 

charges 


Total. 


134 


258 


30 


36 


716      106 


53 


10 


143 

222 

7 

16 

15 

14 

105 

20 

278 

33 
62 


5 

928 


178  HOSPITAL   COMMITTEE 

TABLE   XVIII. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  III.    Aliens  for  Whose  Admissions  the  Authorization  by  Section  6q2,  Subd.  7,  of  the 
City  Charter  Was  Not  Evident. 


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m       m         ^     fq»      d^       H 

1.  Apparently    improperly    admitted    to    the 

United  States 12     2     14 

2.  Apparently  deportable  by  the  United  States 

3.  Apparently  removable  by  State  Board  of 

Charities 10     1     11 

4.  Apparently  removable  by  State  Board  of 

Alienists 1      1     2 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 1     ....  1 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 1     1 

5c.  Apparently  county  or  town  cases  giving  no 

address 

6.  State  Poor  (not  in  other  classes) 9     ....  2     ....         11 

7.  Apparently  charges  of  steamship  company 

8.  Without  settlement  in  the  United  States ...  2         14     8     24 

9.  Without  settlement  in  N.  Y.  State 1     2     3 

10.  State  settlement  unknown 1         10     11 

11.  Claiming  N.  Y.    City   settlement   without 

N.  Y.  City  address 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 

13.  Apparently  justifiable  as  City  charges 

Total 3        58     ....         17     . . . .         78 


ALIENS  AND  NON-RESIDENTS 


179 


TABLE  XIX. 

Bellevue  Hospital. 

Non-Residents  of  New  Yore  City  Admitted  in  the  Year  1912. 

Class  III.    Aliens  for  Whose  Admissions  the  Authorization  hy  Section  6q2,  Subd.  7,  of  the 
City  Charter  Was  Not  Evident. 

Removed  by  rg 


B.   Disposition 


£.0) 

m  o 


^1 


pq'S 
ra'o 


10. 
11. 


12. 
13, 


Apparently  improperly  ad- 
mitted to  the  United  States .  4 

Apparently  deportable  by  the 

United  States 

Apparently  removable  by  State 

Board  of  Charities 5 

Apparently  removable  by  State 

Board  of  Alienists 

Apparently  county  or  town 
cases  with  N.  Y.  City  ad- 
dress    1 

Apparently  County  or  town 
cases  without  N.  Y.  City 
address 1 

Apparently    county    or    town 

cases  giving  no  address 

State     Poor     (not     in     other 

classes) 11 

Apparently  charges  of  steam- 
ship company 

Without    settlement    in     the 

United  States 22 

Without  settlement  in  N.  Y. 

State 3 

State  settlement  unknown.  .  .  9 

Claiming  N.  Y.  City  settle- 
ment without  N.  Y.  City 
address 

Claiming  N.  Y.  City  settle- 
ment with  address  outside 
ofN.Y.  State 

Apparently  justifiable  as  City 
charges 

Total 56 


24 


78 


l8o  HOSPITAL   COMMITTEE 

TABLE   XX. 

Bellevue  Hospital. 

Non-Residents  of  New  York  Citv  Admitted  in  the  Year  1912. 

Class  IV.    Citizens  Whose  Admissions  Were  Authorized  by  Section  dgz,  Subd.  7,  of  the  City 

Charter. 


pa  I 

A.   Admission  "a      S3       „      J  g 


f^ 


me    o|     I    o|     I      ■^ 

m        M  ^      m'-^      c^        H 


1.  Apparently    improperly    admitted    to    the 

United  States 

2.  Apparently  deportable  by  the  United  States 

3.  Apparently  removable  by  State  Board  of 

Charities 17        31  3  4     ....         55 

4.  Apparently  removable  by  State  Board   of 

Alienists 16  3  9  S     ....         36 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 14        25  6  5     50 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 12        20  3  2     ....         37 

5c.  Apparently  county  or  town  cases  giving  no 

address 

6.  State  Poor  (not  in  other  classes) 16        35  5  3     59 

7.  Apparently  charges  of  steamship  company 

8.  Without  settlement  in  the  United  States 

9.  Without  settlement  in  N.  Y.  State 

10.  State  settlement  unknown 

11.  Claiming   N.  Y.    City   settlement   without 

N.  Y.  City  address 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 4  7     11 

13.  Apparently  justifiable  as  City  charges 14        12  1  3        46        76 

Total 93       133        27        25        46      324 


ALIENS  AND   NON-RESIDENTS 


i8i 


TABLE  XXI. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  IV.    Citizens  Whose  Admissions  Were  Authorized  by  Section  6q2,  Subd.  7,  of  the  City 

Charter. 


Removed  by 

"rt 

V. 

"S  S 

•2" 

& 

B.  Disposition 

ok 

g 

t 

Q 

1 

1" 
ra'o 

T3 

2 

3 

1. 

Apparently     improperly     ad- 
mitted to  the  United  States. 

2. 

Apparently  deportable  by  the 
United  States... 

3. 

Apparently  removable  by  State 

Board  of  Charities 

42 

4 

8 

1 

bi) 

4. 

Apparently  removable  by  State 

Board  of  Alienists 

3 

32 

1 

36 

5a. 

Apparently    county    or    town 
cases  with  N.  Y.  City  ad- 

dress   

45 

4 

1 

50 

5b. 

,  Apparently    county    or    town 
cases   without   N.   Y.   City 

address 

30 

(J 

1 

3V 

5c. 

Apparently    county    or    town 
cases  giving  no  address 

fi. 

State     Poor     (not     in     other 

classes) 

51 

2 

6 

59 

7. 

Apparently  charges  of  steam- 
ship company 

8. 

Without    settlement    in    the 
United  States 

9. 

Without  settlement  in  N.  Y. 
State 

10. 

State  settlement  unknown 

11. 

Claiming   N.   Y.   City   settle- 
ment  without   N.   Y.   City 
address 

12. 

Claiming   N.   Y.   City  settle- 
ment with  address  outside 
of  N.  Y.  State 

10 

1 

11 

13. 

Apparently  justifiable  as  City 

charges 

69 

4 

1 

1 

1 

76 

Total 

250 

51 

9 

4 

9 

1 

324 

l82  HOSPITAL   COMMITTEE 

TABLE  XXII. 

Bellevub  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  V.     Citiuns  Whose  Admissions  Were  Not  Authorized  by  Section  6g2,  Subd.  7,  of  the 
City  Charter. 


3 


SS 


A.   Admission  ^"3      S'3       _       ^  g 


m'fi     o's      ^      oj      J        -a 

fq  CQ  ^       pqP        Ph  H 


1.  Apparently    improperly    admitted    to    the 

United  States 

2.  Apparently  deportable  by  the  United  States 

3.  Apparently  removable  by  State  Board  of 

Charities 7  8       146         13     174 

4.  Apparently  removable  by  State  Board  of 

Alienists 1     ....  4     5 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 2  7        38  6     53 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 2  2        41  8     53 

5c.  Apparently  county  or  town  cases  giving  no 

address 9     9 

6.  State  Poor  (not  in  other  classes) 4  5        54        12     ... .         75 

7.  Apparently  charges  of  steamship  company 

8.  Without  settlement  in  the  United  States 

9.  Without  settlement  in  N.  Y.  State 2         10        49  4     65 

10.  State  settlement  unknown 13         17       100         15      145 

11.  Claiming   N.  Y.    City   settlement   without 

N.  Y.  City  address 2     ....         16  3     ....         21 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 18  4     22 

13.  Apparently  justifiable  as  City  charges 4  4 

Total 33        49      475        6.5  4      626 


ALIENS  AND   NON-RESIDENTS 


183 


TABLE  XXIII. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  V.     Citizens  Whose  Admissions  Were  Not  Authorized  by  Section  6g2,  Subd.  7,  of  the 
City  Charter. 


B.   Disposition 


Removed  by 

-?. 

S 

rt-t? 

m 

1 

"O   m 

«'i 

0 

0 

.^i 

^^ 

ra 

-s 

I5m 

CO  0 

1.  Apparently     improperly     ad- 

mitted to  the  United  States. 

2.  Apparently  deportable  by  the 

United  States 

3.  Apparently  removable  by  State 

Board  of  Charities 

4.  Apparently  removable  by  State 

Board  of  Alienists 

6a.  Apparently  county  or  town 
cases  with  N.  Y.  City  ad- 
dress   

5b.  Apparently  county  or  town 
cases  without  N.  Y.  City 
address 

So.  Apparently  county  or  town 
cases  giving  no  address 

6.  State     Poor     (not     in     other 

classes) 

7.  Apparently  charges  of  steam- 

ship company 

8.  Without    settlement    in    the 

United  States 

9.  Without  settlement  in  N.  Y. 

State 

10.  State  settlement  unknown .... 

11.  Claiming   N.   Y.   City  settle- 

ment without   N.   Y.   City 

12.  Claiming   N.   Y.'  City'  settle- 

ment with  address  outside 
of  N.  Y.  State 

13.  Apparently  justifiable  as  City 

diarges 

Total 


125 


47 


62 
122 


20 


516        45 


30 


1     ... 


174 
5 

53 

53 

9 

75 


65 
145 


21 


1  1        22 

1     ....  4 

34  1      626 


l84  HOSPITAL   COMMITTEE 

TABLE  XXIV. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  VI.    Citizens  for  Whose  Admissions  the  Authorization  by  Section  6o2,  Suhd.  7,  of  the 
City  Charter  Was  Not  Evident. 


A.   Admission  jSJ'Sa'g       _       Sg        w 


^t5 


1.  Apparently    improperly    admitted    to    the 

United  States 

2.  Apparently  deportable  by  the  United  States 

3.  Apparently  removable  by  State  Board  of 

Charities 1  9     1     11 

4.  Apparently  removable  by  State  Board  of 

Alienists _. 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 1  7     ....  6     ....  14 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 2     2 

5c.  Apparently  county  or  town  cases  giving  no 

address 4     4 

6.  State  Poor  (not  in  other  classes) 9     ....  5     14 

7.  Apparently  charges  of  steamship  company 

8.  Without  settlement  in  the  United  States 

9.  Without  settlement  in  N.  Y.  State 3     1     4 

10.  State  settlement  unknown 

11.  Claiming  N.  Y.    City   settlement   without 

N.  Y.  City  address 1     1 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 3     2     5 

13.  Apparently  justifiable  as  City  charges 

Total 2        37     ....         16     . . . .         55 


Removed  by 

T) 

T1 

' 

m 

■O  m 

(J 

•a 

M 

5  c3 

01 

u 

'c  'S 

rt 

< 

t^S 

o 

o 

ALIENS  AND   NON-RESIDENTS  185 

TABLE  XXV. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Class  VI.    Citizens  for  Whose  Admissions  the  Authorization  by  Section  6q2,  Subd.  7,  of  the 
City  Charter  Was  Not  Evident. 


B.   Disposition 


1.  Apparently     improperly     ad- 

mitted to  the  United  States 

2.  Apparently  deportable  by  the 

United  States 

3.  Apparently  removable  by  State 

Board  of  Charities 6  2  2     1     11 

4.  Apparently  removable  by  State 

Board  of  Alienists 

5a.  Apparently  county  or  town 
cases  with  N.  Y.  City  ad- 
dress          10  1     3     14 

5b.  Apparently  county  or  town 
cases  without  N.  Y.  City 
address 2     2 

5c.  Apparently    county    or    town 

cases  giving  no  address 3     1     ....     ■     4 

6.  State     Poor     (not    in     other 

classes) 13     1     ....         14 

7.  Apparently  charges  of  steam- 

ship company 

8.  Without    settlement    in     the 

United  States 

9.  Without  settlement  in  N.  Y. 

State 4     4 

10.  State  settlement  unknown 

11.  Claiming   N.   Y.   City   settle- 

ment without   N.   Y.   City 

address 1     1 

12.  Claiming   N.   Y.   City   settle- 

ment with  address  outside 

ofN.Y.  State 5     5 

13.  Apparently  justifiable  as  City 

charges 


Total . 


l86  HOSPITAL   COMMITTEE 

TABLE   XXVI. 

Belle vuB  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Summary  I.    Non-Residents  Whose  Admissions  Were  Authorized  by  Section  6q2,  Subd.  7, 
0}  the  City  Charter. 


0  S  u'^        "O 

A.   Admission                                  ""a  ""S  _       Sg        « 

mJOE  ;a        Oa          3  -g 

P3  cq  g       pqi-'        p,          H 

1.  Apparently    improperly    admitted    to    the 

United  States 7  6     1          7        21 

2.  Apparently  deportable  by  the  United  States 

3.  Apparently  removable  by  State  Board  of 

Charities 40  43  6          5          1         95 

4.  Apparently  removable  by  State  Board  of 

Alienists 83  16        63        25     187 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 20  29          8          5     62 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 19  25  3          3     ....         50 

5c.  Apparently  county  or  town  cases  giving  no 

address 4  1           1     6 

6.  State  Poor  (not  in  other  classes) 39  80          5          3     127 

7.  Apparently  charges  of  steamship  company 2     2 

8.  Without  settlement  in  the  United  States.  . .         20  31          2          2     55 

9.  Without  settlement  in  N.  Y.  State 2  3          1     6 

10.  State  settlement  unknown 

11.  Claiming  N.   Y.    City   settlement   without 

N.  Y.  City  address 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 4  7     11 

13.  Apparently  justifiable  as  City  charges 31  24  3          4        60       122 

Totals 269  267  92        48        68      744 


ALIENS  AND   NON-RESIDENTS 


187 


TABLE   XXVII. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Summary  I.     Non-Residents  Whose  Admissions  Were  Authorized  by  Section  6q2,  Suhd.  7 , 
of  the  City  Charter. 


B.   Disposition 


Removed  by 

Tl 

r/i 

T) 

pq 

^ 

■s^v? 

m 

% 

u 

•  - 1; 

% 

<; 

►5ot 

U} 

0 

t/j 

0 

1.  Apparently     improperly     ad- 

mitted to  the  United  States .         17  2 

2.  Apparently  deportable  by  the 

United  States 

3.  Apparently  removable  by  State 

Board  of  Charities 63         11 

4.  Apparently  removable  by  State 

Board  of  Alienists 33       149 

5a.  Apparently  county  or  town 
cases  with  N.  Y.  City  ad- 
dress           57  4 

5b.  Apparently  county  or  town 
cases  without  N.  Y.  City 
address 40  7 

5c.  Apparently    county    or    town 

cases  giving  no  address 4  1 

6.  State     Poor     (not    in     other 

classes) 107  1 

7.  Apparently  charges  of  steam- 

ship company 2     .... 

8.  Without    settlement    in    the 

United  States 53     

9.  Without  settlement  in  N.  Y. 

State 6     

10.  State  settlement  unknown 

11.  Claiming   N.   Y.   City  settle- 

ment without   N.   Y.   City 

address 

12.  Claiming   N.   Y.   City   settle- 

ment with  address  outside 

ofN.Y.  State 10  1 

13.  Apparently  justifiable  as  City 

charges 112  7 

Total 504       183 


21 

95 

187 

62 

50 
6 

127 

2 

55 


11 

122 

744 


l88  HOSPITAL   COMMITTEE 

TABLE   XXVIII. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Summary  II.   Non-Residents  Whose  Admissions  Were  Not  Authorized  by  Section  6q2,  Subd.  7, 
of  the  City  Charter. 


A.   Admission 


2-3 


ma     o 


2 

it 


1. 


the 


4. 


Apparently    improperly    admitted 

United  States 

Apparently  deportable  by  the  United  States. 
Apparently  removable  by  State  Board  of 

Charities 

Apparently  removable  by  State  Board  of 

Alienists 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 

5c.  Apparently  county  or  town  cases  giving  no 

address 

State  Poor  (not  in  other  classes) 

Apparently  charges  of  steamship  company . . 
Without  settlement  in  the  United  States .  . . 

Without  settlement  in  N.  Y.  State 

State  settlement  unknown 

Claiming  N.  Y.    City   settlement   without 

N.  Y.  City  address 

Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 

Apparently  justifiable  as  City  charges 

Total 


2 

184 


13       104 


143 


24 

31 

304 

37  .. 

.   396 

1 

3 

8 

12 

7 

7 

49 

6  .. 

69 

2 

6 

49 

11  .. 

68 

1 

22 

23 

25 

15 

119 

21  .. 

180 

12 

5 

1 

2    20 

81 

34 

136 

27  .. 

278 

7 

13 

74 

4  .. 

98 

21 

21 

145 

20  .. 

.   207 

2 

16 

3  .. 

21 

25 

5  .. 

30 

156    1,056       149 


6  9 

9    1,554 


ALIENS  AND   NON-RESIDENTS  189 

TABLE  XXIX. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  tee  Year  1912. 

Summary  II.  Non-Residents  Whose  Admissions  Were  Not  Authorized  by  Section  6g2,  Suhd.  7, 
of  the  City  Charter. 


B.   Disposition 


Q        H 

Apparently  improperly  ad- 
mitted to  the  United  States .         86        30 

Apparently  deportable  by  the 

United  States 

Apparently  removable  by  State 

Board  of  Charities 259        66        66 

Apparently  removable  by  State 

Board  of  Alienists 1         11     .... 

Apparently  county  or  town 
cases  with  N.  Y.  City  ad- 
dress          62  3     

Apparently  county  or  town 
cases  without  N.  Y.  City 
address 55  4     .... 

Apparently    county    or    town 

cases  giving  no  address 20  2     .... 

State    Poor     (not    in     other 

classes) 153         15     .... 

Apparently  charges  of  steam- 

diip  company 16  3     .... 

Without    settlement    in    the 

United  States 258  1     

Without  settlement  in  N.  Y. 

State 93     1 

State  settlement  unknown ....       177         13  1 

Claiming  N.  Y.  City  settle- 
ment without  N.  Y.  City 
address 17  3     

Claiming  N.  Y.  City  settle- 
ment with  address  outside 
N.Y.  State 27     

Apparently  justifiable  as  City 

charges 8     

Total 1,232      151        83 


Removed  by 

T) 

W 

•n 

0! 

01 

•c 

m 

■rt  ,„ 

PP 

01 

d 

Cl 

< 

w 

0 

IsS 

M 

"0 

10. 

11. 


12. 
13. 


15 


10 


143 

396 
12 

69 


1 

23 

11 

1 

180 

1 

20 

18 

1 

278 

4 
16 

98 
207 

1 

21 

2 

1 

30 

82 


4   1,554 


190  HOSPITAL   COMMITTEE 

TABLE  XXX. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Summary  III.    Non-Residents  for  Whose  Admissions  the  Authorization  by  Section  dps, 
Siibd.  7,  oj  the  City  Charter  Was  Not  Evident. 


>  oJ  aJ  u  d           p^ 

A.   Admission                                 s|  .SI  -v      |I        S 

pq  «  ^       m'^        Ph         h 

1.  Apparently    improperly    admitted    to    the 

United  States 12     2     14 

2.  Apparently  deportable  by  the  United  States 

3.  Apparently  removable  by  State   Board   of 

Charities 1  19  . . . .           2     ....         22 

4.  Apparently  removable  by  State  Board  of 

Alienists 1      1     2 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 1  7     7     15 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 3     3 

5c.  Apparently  county  or  town  cases  giving  no 

address 4     4 

6.  State  Poor  (not  in  other  classes) 18  ....           7     ....         25 

7.  Apparently  charges  of  steamship  company 

8.  Without  settlement  in  the  United  States ...           2  14     8     24 

9.  Without  settlement  in  N.  Y.  State 4     3     7 

10.  State  settlement  unknown 1  10     11 

11.  Claiming   N.   Y.   City    settlement   without 

N.  Y.  City  address 1     1 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 3     2     5 

13.  Apparently  justifiable  as  City  charges 

Total 5  95  ....         33     . . . .       133 


ALIENS  AND   NON-RESIDENTS  191 

TABLE  XXXI. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Summary  III.    Non-Residents  for  Whose  Admissions  the  Authorization  by  Section  6q2, 
Subd.  7,  of  the  City  Charter  Was  Not  Evident. 


Removed  by 

1 

■d 

"S 

V.  s 

"O  ,„ 

^ 

B.   Disposition 

^ 

£ 

o.t; 

.^ 

^ 

1)  J3 

•0 

B 

"rt 

Q 

H 

w'o 

►5ra     m'o 

Q 

CO 

H 

1. 

Apparently     improperly     ad- 

mitted to  the  United  States. 

4 

5 

1 

4     .... 

14 

2. 

Apparently  deportable  by  the 
United  States 

3. 

Apparently  removable  by  State 

Board  of  Charities 

11 

7 

3 

1 

22 

4. 

Apparently  removable  by  State 
Board  of  Alienists 

2 

2 

5a. 

Apparently    county    or    town 
cases  with  N.  Y.  City  ad- 

dress   

11 

1 

3 

15 

5b 

Apparently    county    or    town 
cases  without   N.   Y.   City 
address 

3 

3 

5c. 

Apparently    county    or    town 
cases  giving  no  address 

3 

1 

4 

6. 

State     Poor     (not    in     other 
classes) 

24 

1 

25 

V. 

Apparently  charges  of  steam- 
ship company 

8. 

Without     settlement    in     the 

United  States 

22 

1 

1 

24 

9. 

Without  settlement  in  N.  Y. 
State 

7 

7 

10. 

State  settlement  unknown .... 

9 

2 

11 

11. 

Claiming   N.   Y.   City   settle- 
ment without   N.   Y.   City 
address 

1 

1 

12. 

Claiming   N.   Y.   City   settle- 
ment with  address  outside 
of  N.Y.  State 

5 

s 

13. 

Apparently  justifiable  as  City 
charges 

Total 

100 

18 

4 

4     .... 

7 

133 

192 


HOSPITAL   COMMITTEE 


TABLE   XXXII. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Grand  Summary. 


A.   Admission 


3  C 
>  oJ 

.2  "3 
~-^ 
cq  E 
>.< 
P3 


1.  Apparently    improperly    admitted    to    the 

United  States 19 

2.  Apparently  deportable  by  the  United  States. 

3.  Apparently  removable  by  State  Board  of 

Charities 

4.  Apparently  removable  by  State  Board  of 

Alienists 

5a.  Apparently  county  or  town  cases  with  N.  Y. 

City  address 

5b.  Apparently  county  or  town  cases  without 

N.  Y.  City  address 

5c.  Apparently  county  or  town  cases  giving  no 

address 

6.  State  Poor  (not  in  other  classes) 

7.  Apparently  charges  of  steamship  company. . 

8.  Without  settlement  in  the  United  States .  .  . 

9.  Without  settlement  in  N.  Y.  State 

10.  State  settlement  unknown 

11.  Claiming   N.  Y.    City   settlement   without 

N.  Y.  City  address 

12.  Claiming  N.  Y.  City  settlement  with  address 

outside  of  N.  Y.  State 

13.  Apparently  justifiable  as  City  charges 

Total 458 


31       104 


8       178 


65 

93 

310 

44 

1   513 

84 

20 

71 

26 

. .  . .   201 

28 

43 

57 

18 

. . . .   146 

21 

34 

52 

14 

. . . .   121 

4 

6 

23 

33 

64 

113 

124 

31 

. . . .   332 

14 

5 

1 

2    22 

103 

79 

138 

37 

. . . .   357 

9 

20 

75 

7 

111 

22 

31 

145 

20 

. . . .   218 

2 

16 

4 

22 

4 

10 

25 

7 

46 

33 

24 

3 

5 

66   131 

518    1,148      230        77   2,431 


ALIENS  AND   NON-RESIDENTS 


193 


TABLE  XXXIII. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

Grand  Summary. 


B.   Disposition 


Removed  by 

Tl 

f« 

•n 

CQ 

n1 

•a  w 

m 

S 

% 

6 

■n 

« 

^ 

CO 

0 

Pw 

m 

0 

a     ^ 


1.  Apparently     improperly     ad- 

mitted to  the  United  States. 

2.  Apparently  deportable  by  the 

United  States 

3.  Apparently  removable  by  State 

Board  of  Charities 

4.  Apparently  removable  by  State 

Board  of  Alienists 

5a.  Apparently  county  or  town 
cases  with  N.  Y,  City  ad- 
dress   

5b.  Apparently  county  or  town 
cases  without  N.  Y.  City 
address 

5c.  Apparently  county  or  town 
cases  giving  no  address 

6.  State    Poor     (not    in    other 

classes)  

7.  Apparently  charges  of  steam- 

ship company 

8.  Without    settlement    in     the 

United  States 

9.  Without  settlement  in  N.  Y. 

State 

10.  State  settlement  unknown. . . . 

11.  Claiming   N.   Y.   City  settle- 

ment  without  N.   Y.   City 

12.  Claiming   n!   Y.   City   settle- 

ment with  address  outside 
of  N.  Y.  State 

13.  Apparently  justifiable  as  City 

charges 


130 


37 


333        84 
34      162 


27 

284 


18 
333 


106 
186 


120 


16 


84 


1 


Total. 


1,833      352       105         11 


10 


178 


513 
201 


1       146 


10 

1 

121 

3 

33 

29 

1 

332 

1 

22 

21 

1 

357 

4 
16 

111 
218 

1  ....  22 

2  1  46 

2  ....  131 

115          9  2,431 


194  HOSPITAL   COMMITTEE 

XXXV. 

Bellevue  Hospital. 

Admissions  of  Non-Residenls  of  New   York  City  in  igi2,  Classified  According  to  Length  of 
Stay  in  the  City. 

In  City  Less  Than  * 

'      1  3  1  ~l  2  G  P 

Day        Days       Week      Month  Months  Months      Year       Total 

Aliens: 

Class  1 106  26  25  46  51  107  59  420 

Class  II 85  30  53  124  121  324  191  928 

Class  HI 6  7  7  13  13  22  10  78 

Citizens: 

Class  IV 172  13  24  51  15  31  IS  324 

Class  V 145  30  53  106  58  16S  66  626 

Class  VI 15  6  7  11  1  10  5  55 

Total 529  112  169  351  259  662  349       2,431 

21.8%      4.6%      6.9%     14.4%     10.7%    27.2%     14.4%       100% 

Cumulative  To- 
tals   529  641  810       1,161        1,420       2,082       2,431     

Cumulative   Per- 
centages      21.8%    26.4%     33.3%    47.7%     58.4%    85.6%       100%,     

*  In  each  column  all  figures  (except  the  cumulative  totals  and  cumulative  percentages) 
exclude  the  figures  in  the  preceding  columns. 


TABLE  XXXIV. 

Bellevue  Hospital. 

Non-Residents  of  New  York  City  Admitted  in  the  Year  1912. 

This  table  shows  the  non-residents  classified  according  to  their  length  of  stay  in  New  York  State,  the  patients  admitted  being  divided  as:  those  who 
had  been  less  than  2  months  in  the  State;  those  who  had  been  from  2  months  to  i  year  in  the  State;  those  whose  time  in  the  State  is  unknown;  and  those 
in  the  Stale  for  i  year  and  over — with  the  total  number  of  days  of  stay  and  expense  of  the  hospital  care  of  each  group.  Also,  an  estimate  is  given  of  the 
total  expense  of  patients  in  the  State  less  than  z  months  and  of  those  who  had  been  in  the  State  less  than  i  year,  exclusive  of  the  cost  of  grounds,  buildings, 
and  equipment. 

Patients  in  New  York  State. 


Less  Than  2  Months 
Patients  Not  Paid  For        Patients  Paid  For 


^W3 


ALIENS. 
Class  I. 

Aliens  whose  admissions  were  au- 
thorized by  Sec.  692,  Subd.  7,  of 
the  City  Charter 

Class  II. 

Aliens  whose  admissions  were  not 
authorized  by  Sec.  692,  Subd.  7, 
of  the  City  Charter 

Class  III. 

Aliens  for  whose  admissions  the  au- 
thorization by  Sec.  692,  Subd.  7, 
of  the  City  Charter  was  not  evi- 
dent   

SUMMARY  I 

Percentages  of  aliens  classified  for 

State  residence 

Cumulative  percentages  of  aliens 
classified  for  State  residence 

CITIZENS. 
Class  IV. 

Citizens  whose  admissions  were  au- 
thorized by  Sec.  692,  Subd.  7,  of 
the  City  Charter 


.03  15    S:68.50  172 


242   2,876       5,205.56  2        19.50  529     107 


22       300  543.00 


39       15 


421    4,739     $8,577.59  17    S3S8.00  740     170   $10,125.71   $27,235.30  78 

33.6%     1.3%     59.0%     ...  6.2% 

33.5%     : 34.8%     93.8%     ...  100.0% 


127      807     $1,460.67 


Class  V. 

Citizens  whose  admissions  were  not 
authorized  by  Sec.  692,  Subd.  7, 
of  the  City  Charter 


Class  VI. 

Citizens  for  whose  adi 

thorization  by  Sec.  692,  Subd.  7, 
of    the    City    Charter    was   not 

evident 

SUMMARY  n 

Percentages  of  citizens  classified  for 

State  residence 

Cumulative  percentages  of  citizens 

classified  for  State  residence.... 

GRAND  SUMMARY,  ALIENS  AND 
CITIZENS 

Percentages  of  aliens  and  citizens 
classified  for  State  residence 

Cumulative  percentages  of  aliens 
and  citizens  classified  for  State 
residence       


187  1,596   2,888.76 


28   197    356.57 


9   11 


1,426 
100% 


342  2,600  $4,706.00  22  .5182.00  165  250  6,673.68   9,688.40    226  1,005 

45.3%     2.9%  21.9%  ...  29.9%  100% 

45.3%     48.2%  70.1%  ...  100.0%     

763  7,339   $13,283.59  39  -5470.00  905  420  $16,799.39    $36,923.70          304  2,431 

38%     2%  45%  . . .  15%  100% 

38%     40%  Si%  . . .  106%     


"  These  figures  include  a  pro  rata  of  the  admissions  of  those  whose  time  in  the  United  States  was  unknown. 


dT.888;S 


ALIENS  AND   NON-RESIDENTS  I95 

TABLE  XXXVI. 

Bellevue  Hospital. 

Non-Resident  Citizens  Admitted  in  1912. 

Classified  According  to  the  Apparent  Contraction  of  Ailment  Before  or  After   Coming  to 
New  York  City. 


Class  IV  ■■ 


Class  V  * 


Class  VI 


Total 


^       5 


Acutef  Gonorrhea 

Acute  Diseases  of  Heart  and 
Circulatory  System 

Acute  Diseases  of  Male  Gen- 
ital Organs 

Acute  Diseases  of  Female 
Genital  Organs 

Acute  Rheumatism 

Malaria 

Acute  Diseases  of  Respira- 
tory System 

Acute  Diseases  of  Nervous 
System 

Typhoid  Fever 

Other  Epidemic  Diseases.  . 

Chronic  Rheumatism 

Acute  Syphilis 

Chronic  Diseases  of  Male 
Genital  Organs 

Chronic  Diseases  of  Female 
Genital  Organs 

Tuberculosis  of  Lungs 

Other  Tubercular  Diseases . 

Drug  Habit 

Chronic  Diseases  of  Respira- 
tory System 

Chronic  Diseases  of  Heart 
and  Circulatory  System . . 

Chronic  Diseases  of  Diges- 
tive System 

Chronic  Syphilis 

Parturition 

Cancer  and  Tumor 

Chronic  Alcoholism 

Epilepsy 

Other  Diseases  of  Nervous 
System 

Insanity 

Hernia 

Acute  Diseases  of  Digestive 
System 

Alcoholism 

Pregnancy 

Causes  not  elsewhere  speci- 
fied  

Traumatism,  Bums,  etc.  .  . 


66 

4 

7 

75 

2 

18 
53 


5 

27 

1 

4 

8 

8 

1 

8 

1 

9 

4 

9 

2 

19 

2 

3 

1 

4 

9 

2 

2 

14 

9 

5 

1 

7 

8 

39 

5 

5 

4 

12 

2 

29 


7 
24 

4 
10 

3 


7 
14 

46 

123 

14 

63 
18 


3 
15 


17 


52  7 
5  4 
17    3 


54  4 

10  3 

8  1 

30  2 
5 


73 

18 

56 

213 

16 

85 

75 


87  12  225  205  136  285  23   6  26  315  154  536 


*  The  constitution  of  Classes  IV,  V,  and  VI  will  be  found  by  referring  to  Tables  VII, 
VIII,  and  IX. 

t  Acute  here  and  elsewhere  in  this  table  is  applied  to  all  diagnoses  not  shown  to  be 
chronic. 


196  HOSPITAL   COMMITTEE 

TABLE  XXXVII. 

Bellevue  Hospital. 

Admissions  of  Non-Residents  of  New  York  City  in  1912. 

This  table  shows  the  hospital  diagnoses  of  patients  indicated  by  the  records  as  not  having 
had  a  legal  settlement  in  New  York  City. 

The  numbers  and  percentages  of  patients  having  certain  diagnoses  are  shown  for  aliens 
and  for  citizens  separately;  and  the  numbers  only  for  the  following  subdivisions  under  aliens 
and  under  citizens:  Classes  I  and  IV,  those  whose  admissions  were  authorized  by  Section  692, 
Subdivision  7,  of  the  City  Charter;  Classes  II  and  V,  those  whose  admissions  were  not  authorized; 
Classes  III  and  VI,  those  for  whose  admissions  the  authorization  was  not  evident. 

Aliens 


Class  Class  Class 
I        II      III 


Total 

Citizen 

s 

Total 

Total 

Per 
Cent. 

Class  Class  1 
IV        V 

Class 
VI 

Total 

Per 
Cent. 

121 

8.5 

7 

44 

8 

59 

5.9 

12 

0.8 

9 

9 

0.9 

5 

0.4 

5 

32 

3 

40 

4.0 

39 

2.8 

3 

31 

2 

36 

3.6 

1 

0.1 

6 

6 

0.6 

7 

0.5 

2 

15 

17 

1.7 

184 

12.9 

66 

7 

73 

7.3 

2 

0.2 

4 

3 

7 

0.7 

28 

2.0 

8 

8 

1 

17 

1.7 

20 

1.4 

4 

14 

IS 

1.8 

19 

1.3 

12 

10 

2 

24 

2.4 

6 

0.4 

1 

4 

5 

0.5 

Tuberculosis  of  the  Lungs.     14  103  4 

Other  Tubercular  Diseases  ...  11  1 

GonoiThea 2  3  ... 

Syphilis 6  32  1 

Chronic  Diseases  of  Male 

Genital  Organs 1 

Chronic    Diseases    of   Fe- 
male Genital  Organs 7 

Insanity 166  16  2 

Epilepsy 2  ... 

Other  Diseases  of  Nervous 

System 8  18  2 

Hernia 1  19  ... 

Chronic  Alcoholism 9  10  ... 

Chronic  Rheumatism 2  4  ... 

Chronic   Diseases   of   Re- 
spiratory System 1  7         1          9        0.6          1     1        0.1 

Chronic  Diseases  of  Heart 

and  Circulatory  System.      2  18  4        24        1.7        21      32        5        58        5.8 

Chronic  Diseases  of  Diges- 
tive System 1  4  ...           5 

Cancer  and  Tumor 3  9  1         13 

Typhoid  Fever 7  ...           7 

Other  Epidemic  Diseases 

Malaria 1  IS  4        20 

Alcoholism  and  Drug 

Habit 41  63  13       117 

Parturition 3  38  . . .         41 

Pregnancy 3  17  ...         20 

Erysipelas 11  50  10        71 

CeUulitis 14  2        16 

Acute  Rheumatism 4  35  7        46 

Acute    Diseases    of    Male 

Genital  Organs 8  66  3        77        5.3          6      16        2        24        2.4 

Acute  Diseases  of  Female 

Genital  Organs 1  15  2        18        1.3       ...         9     ...           9        0.9 

Acute  Diseases  of  Nervous 

Systern 2  2        0.2        10        5       ..         15         1.5 

Acute  Diseases  of  Respira- 
tory System 3  66  ...         69        4.8       ...       21         1        22        2.0 

Acute   Diseases   of  Heart 

and  Circulatory  System.       4  5  ...           9        0.6          4        5     ...           9        0.9 

Acute  Diseases  of  Diges- 
tive System 7  92  2      101        7.3        12      60        4        76        7.6 

Causes  not  elsewhere  speci- 
fied       30  127  8      154 

Traumatism,  Bums,  etc...     98  54  11       163 

Total 420  928  78    1,426     100.0      324    626      55    1,005     100.0 


0.4 

2 

10 

1 

13 

1.0 

0.9 

1 

4 

5 

0.5 

0.5 

1 

1 

0.1 

13 

13 

1.0 

1.4 

1 

13 

1 

15 

1.5 

8.0 

75 

123 

15 

213 

22.0 

2.9 

4 

26 

2 

32 

3.0 

1.4 

2 

14 

16 

1.6 

4.9 

1.1 

3.2 

2 

10 

12 

1.0 

10.8 

IS 

63 

4 

85 

8.5 

11.4 

53 

18 

4 

75 

7.5 

TABLE  XXXVIII. 

Bellevtje  Hospital. 

Patients  Admitted  from  May  19,  1913,  to  June  18,  1913,  Arranged  According  to  Length  of  Stay  in  the  United  States. 

[  a  period  oj  31  days,  classified  according  to  tlieir  citizenship 


This  table  shows  tlie  total  admissions  of  patients  to  Bellevue  Hospital  \ 
in  the  United  States,  and  their  residence  or  non-residence  iji  New  York  City. 

In  this  table  tlie  aliens  are  divided  into  classes  according  to  tlieir  presence  in  the  United  States  in  violation  of  tlie  Federal  Immigration 
Law,  and  their  eligibility  to  deportation  under  the  Federal  Immigration  Law,  the  St<ite  Charities  Law,  or  tlie  State  Insanity  Law. 


Aliens  in  United  States  Les3  Than 


;LASS  I.     ALIENS. 

1.  Aliens  in  the  United  States  in  viola- 

tion of  the  Federal  Immigration 

2.  Aliens  deportable  under  the  Federal 


Charities  Law: 

Prom    causes    existing    prior    to 

landing 

,  From    causes   whose   priority   to 

From  causes  existing  subsequent 


4.   Aliens  deportable  (with  consent)  i 


1,344.83 


1,158.40 
2.885.  U 


213       2,473       $4,476.13 


s    whose    priority    to 
i  existing  subsequent 


SUMMARY  A.  ALIEMS  DEPORTABLE. 


82 

293 

S530.33   .. 

10 

S3 

94 

12   .. 

5 

39 

70 

59   .. 

67 

334 

S695 

04   .. 

333 
5,630 

4.144 
60,917 

S7.600 
SlIO,259 

64 

1    !16 
5   SJ4J 

SO 
55 

i.    Aliens  whose  deportation  might 
not  have  been  humane: 

a.  Likely  to  become  chronic  or 
recurrent  dependents 

b.  Seemingly  temporary  depend- 


63        43       183 


142       1,402       82,537.62     

337       4,443         8,011.83        4       8102.50 


Estimated  total  for  i  yearf 

SUMMARY  B.      ALIEN    PATIENTS. 
Total 

Cumulative  Totals  of  Aliens 

Cumulative  Percentages  of  Aliens. ,  . 

Estimated  total  for  i  yeorf 

CLASS     II.       CITIZEN      NON-RESI- 
DENTS OF  NEW  YORK  CITY 

Estimated  total  for  i  yearf 

SUMMARY  C 
".ESIDENT  P 
olal 

Estimated  total  for  i  yearf  . 


3       13       12      31 

8      21       33       64 

1.0    2.5    3.9     7.5 


112  499 
363  862 
42.1  100.0 


862  0.989     813,080.09  5      8119.00 

13.671  146.838    $365,777.63  74    $1,749-30 

161  1.918        83,471 .  58  7         $72 .60 

3,411  38,195      J5i.033.a8  103    $i,ofis.72 

1,026  11,907     821,551.67  12      8191.60 

IS.O83  175.033     8316,809.91  177      $2,8lS03 


SUMMARY     D.        CLASSIFIED     AS 
ALIENS  AND  CITIZENS. 
Total 

CLASS    IV.     INCOMPLETE     HISTO- 


_     Pnsonera 

3.  Histories  unfinished  because  of  death 

4.  Histories  incomplete  because  of  early 


GRAND  TOTAL  OF  ADMISSIONS., 


a  of  ^e  admissions  in  Class  IV. 


TABLE  XXXIX. 
Bellevue  Hospital. 


Aliens  Admitted  from  May  19,  1913, 


.  Ju 


18,  1913,  Within  5  Years  of  Landing  in  the  United  States. 


This  table  shows  all  the  admissions  of  aliens  to  Bellevue  Hospital  in  a  period  of  3T  days  who  had  been  in  the  United  States  less  than  5 
years,  classified  according  to  their  presence  in  tlie  United  States  in  violation  of  the  Federal  Immigration  Law,  and  their  eligibility  to  deportation 
under  the  Federal  Immigration  Law,  tlie  Slate  Charities  Law,  or  tlie  State  Insanity  Law. 

In  this  table  the  aliens  are  assembled  into  three  groups:  tlwse  wlw  have  been  in  the  United  States  less  than  i  year;  those  who  havebeen  in 
the  United  States  less  than  3  years  {including  those  less  than  i  year);  those  who  have  been  in  the  United  States  less  than  5  years  (including 
those  less  than  3  years).  The  days  stay  up  to  September  p,  igi3,  of  the  patients  in  each  of  tJiese  groups  and  the  expense  to  tlie  City  is  shown 
for  each  class,  subdivision,  and  summary,  and  also  tlie  estimated  total  days  stay  and  expense  for  deportable  aliens,  and  for  all  aliens  under 
the  three  groups. 


Days 

Stay* 


Expense 


In  United  States  Less 
Than  3  Years 


Num-     Days 
ber       Stay* 


Espen 


In  United  States  Less 
Than  5  Years 


Days 
Stay* 


CLASS  I.    ALIENS. 

1.  Aliens  in  the  United  States  in  violation  of 

the  Federal  Immigration  Law 

2.  Aliens  deportable  under  the  Federal  Im- 

migration Law 

3.  Aliens  deportable  under  the  State  Chari- 

ties Law; 

a.  From  causes  existing  prior  to  landing.  . 

b.  From  causes  whose  priority  to  landing 

is  not  certain 

c.  From   causes   existing   subsequent   to 

landing 


,.    Aliens  deportable  (with  consent)  under 
the  State  Insanity  Law: 

a.  From  causes  existing  prior  to  landing. . 

b.  From  causes  whose  priority  to  landing 

is  not  certain 

c.  From    causes  existing   subsequent    to 

landing 


$495-94 
676.94 


464 
743 


S233-49 
139-37 


$514-04 
517-66 


304 
533 


S12.67 
7.24 


$852.51 
1.344-83 

Si 19. 46 
550.24 
964-73 


206  S372 .86  42         570        $1,031 .70  74        903        $1,634.43 


169  $305.; 


SUMMARY  A.    ALIENS  DEPORTABLE. 

Total 

Estimated  total  for  i  yearf 


5.    Aliens  whose  deportation  might  not  have 
been  humane: 

a.  ''  ikely  to  become  chronic  or  recurrent 

dependents 

b.  Seemingly  temporary  dependents 

Estimated  total  for  i  yearf 


SUMMARY  B.     ALIEN  PATIENTS. 

Total 

Estimated  total  for  i  yearf 


76        854       Sr,545-74 
,117    12,554     322,722.38 


43         510  $923-^0 

632     7i497     *i3i569-57 


1,788        53,236.28         208      2,301 
26,284     847,573-32     3,058   33,825 


$76.02 
!,42i.78 


34,164-81 
861,222.71 


$97-74 
3.491.49 


109      1,380       $2,497.80         155      1,983       $3,589.23 
1,602   20,286     836,717.66     2,279    29,273      $52,761.68 


119      1,364       $2,468.84        251      3,168        $5,734' 
[,749   20,051      $36,291.95     3,690   46,570     $84,290.* 


363      4,284       $7,754.04 
5,336    62,975    S1131984.39 


*  These  figures  are  for  the  period  between  the  date  of  each  admission  and  September  9,  1913. 
t  These  figures  include  a  pro  rata  of  the  admissions  in  Class  IV,  Table  XXXVIII. 


TABLE  XL. 

Bellevue  Hospital. 

Patients  Admitted  from  May  19,  1913,  to  June  18,  1913,  Arranged  According  to  Length  of  Stay  in  New  York  State. 

V  a    n'Vftf^'^'^^f,  '^"^  "^"""W"^  "/  P<^ti^nls  la  Bellevue  Hospital  in  a  period  of  31  days,  classified  according  to  their  citizenship 
««  the  United  States,  and  lltetr  residence  or  non-residence  in  New  York  State.  ^  •  j  s  "  >-ni.i^iniity 


In  this  table  the  aliens  are  divided  into  classes  according  to  the.- 
Law,  and  their  eligibility  to  deportation  under  the  Federal  Immigration  Law, 


in  the  United  States  in  violation  of  the  Federal  Immigratii 
State  Charities  Law,  or  tlie  State  Insanity  Law. 
New  York  Stats. 


Less  Than  2  Months         ^^^^  P??  \  J^"'  '° 


ALIENS, 
s  in  the  Un    .  _    .  ..  _ 
n   of   the  Federal    In; 


3.   Aliens    deportable    under    the    State 


S2I7.20 
369.24 


S30.77 
36.20 


lis 
P.9| 


1    whose  priority    to 
existing    subsequent 


4.   Aliens  deportable  (with  consent)  1 


S5.43 
30.20 
121.27 


S7.24 
182.81 
434.40 


S624.45       6       53      895.93 


6       159       213 


b.  From    causes     whose     priority     to 

landing  is  not  certain 

c.  From   causes  existing     subsequent 

to  landing 

SUMMARY  A.  ALIENS  DEPORTABLE. 

Total 

Estimated  total  for  i  yearf 

5.   Aliens  whose  deportation  might  not 
have  been  humane: 

a.  Likely  to  become  chronic  or  recur- 

rent dependents 

b.  Seemingly  temporary  dependents. . 


SimMARY  B.    ALIEN  PATIENTS. 


9 

72 
30 

J130.32 
54.30 

42 
10 
2 

212 
62 
0 

$383.72 
94.12 
16.29 

3 

12 

102 

J184.62 

64 

273 

$494.13 

l.osS 

545 

$986.45 
Si6,3o6.8o 

63 
.117 

669      Sl.210.89 
0,892    $19,732.12 

07 

363 

$657.03 

2 
16 

9 
232 

$16.29 
419.92 

"46 

"652 

"$999!  12 

1 
3 

6 
32 

$10.86 
67.92 

18 

241 

$436.21 

46 

552 

$999.12 

4 

38 

$68.78 

Tolal. 

Estimated  total  for  ] 
Percentages    of    Aliens    classified    for 

State  residence 9.7% . 


109      1.221      S2.210.01     71     401     $725.81      $1,828.12      $4,658.1 


CLASS  II.    CITIZEN  NON-RESIDENTS 

OP  NEW  YORK  CITY.. 

Estimated  total  fo 

Percentages  of  Citizen  Non-residents 

classified  for  State  residence 

SDMMAHY    C.     ALIEN    AND    NON- 
RESIDENT  PATIENTS. 


CLASS  III.    CITIZEN  RESIDENTS  OP 
NEW   YORK    CITY 

SUMMARY      D.       CLASSIFIED 
ALIENS   AND   C. 

Total  . 


77         841      $1,522.21 


1.749    18,757    $33,959. 50 
13.8% 

733      81,326.73 


$21,937-44    $55,907.52 


1.027      82.944.87 


1,367    24.490    $44,333.58    2,616    29, 
.6.1% 17.6% 


1.954      $3,536.74     71     401     8725.81      $3,91 


$44,313.96    $97,786.92 


ALIENS   AND   CITIZENS. 


3   136   142 
2   270   337 

6  406  479 
11  594  862 
1.4%75.1%.... 


17%   

39   694  l.C 

4.1%  62.2%  .. 

1.793  1,! 


TABLE   XLI. 

Bellevue  Hospital. 

Patients  Admitted  from  May  19th,  1913,  to  June  18th,  1913,  Arranged  According  to  Length  of  Stay  in  New  York  City. 

period  of  31  days,  classified  according  to  their  citizenship  in 


This  table  shows  the  total  admissions  of  patients  to  Bellevue  Hospital  in 
the  United  Stales,  and  their  residence  or  non-residence  in  New  York  City. 

In  this  table  the  aliens  are  divided  into  classes  according  to  tlieir  presence  in  the  United  States 
Law,  and  their  eligibility  to  deportation  under  the  Federal  Immigration  Law,  the  State  Charities  Law, 

Patients  m  New  York  City. 


»  violation  of  the  Federal  Immigratu 
'  the  State  Insanity  Law. 


Total  Less  Than  1  Year        %         ^'^ 


3  I.     ALIENS. 

Uiene  in  the  United  States  i 

violation  of  the  Federal  In 

migratio 
Uiens    de; 

Federal  _ 
3.    Aliens    deportable    under    the 


S523.09 
702.28 


to  landing 
to  landing 
quent  to  landing 


whose  priority 
existing  subse- 


ns    deportable    (with    con- 
int)    under  the  State  Insun- 

rom   causes   enlisting   prior 

whose  priority 


$12.67 
264.26 


48       484       $876.04 


72        S130.32       42 


quent  to  landing. 

JMMARY     A.     ALIENS     DE- 
PORTABLE. 

To:al 

Aliens  whose  deportation  might 


12       102       S184.G2 


b.   Seemingly     temporary     de- 


SUMMARY    B. 
TIENTS, 
Total 


{34.30 
1.478.77 


6s     197    a.099    $3,799.19 


3       $98.00       270       337 
3       $98.00       406       479 


$114.50       594       86a 


4.2%     6.2%     7,6%   10.3%   17.7%  25  1 


CLASS  II.    CITIZEN  NON-RESI- 


$4,353.69  7       $73.50     164 


1  Non-residenta 7  9%     21.4%  27  6%       47%  W   1%  82.' 


Cumulative  Totals  of  Alien  and 
Non-resident  Patients 

Cumulative  Percentages  of  Alien 
and  Non-reeident  Patients 
(with  residence  known) 3.1 

;LASS  III.        CITIZEN      RESI- 
DENTS OF  NEW  YORK  CITY      .. 


17.7%  28.2%  37.9% 


J187.00         594  1 


100% 
1.793    1.: 


SUMMARY    D. 


CLASSIFIED 


AS    ALIENS  AND   CITIZENS. 


and  September  9,  1313. 


1  Class  IV.  Table  XXX'VIIl 


ALIENS  AND   NON-RESIDENTS 


197 


TABLE  XLII. 

Bellevue  Hospital. 

Aliens  Admitted  from  May  19,  1913,  to  June  18,  1913,  as  Public  Charges  from 
Causes  Existing  Prior  to  Landing  in  the  United  States. 

This  table  shows  the  causes  of  the  dependence  of  the  patients  that  were  classified  in  Table 
XXXVIII  of  this  Report  under  Class  i  as:  1 — Aliens  in  the  United  States  in  violation  of 
the  Federal  Immigration  Law;  2 — Aliens  deportable  under  the  Federal  Immigration  Law; 
3a — Aliens  deportable  under  the  State  Charities  Law  from  causes  existing  prior  to  landing; 
4a — Aliens  deportable  (with  consent)  under  the  State  Insanity  Law  from  causes  existing  prior 
to  landing. 

In  this  table  the  diagnoses  are  separated  into  those  of  aliens  that  are  mandatorily  excludable 
and  must  be  deported  under  the  Immigration  Law,  and  those  that  may  be  certified  by  the  Med- 
ical Officers  as  "affecting  ability  to  earn  a  living"  which  may  cause  deportation. 


Diagnoses  of  Diagnoses  of  Patients 

Patients  Mandatorily  Certifiable  as  "affecting 

Excludable  ability  to  earn  a  living." 


Pulmonary  Tuberculosis 

Venereal  Diseases 

Insane 

Epilepsj' 

Urethral  Fistula 

Hypospadias 

Salpingitis 

Hernia 

Chronic  Alcoholism 

Chronic  Cardiac  Disease 

Cnronic  Gastritis 

Joint  Affections 

Chronic  Arthritis 

Acute  Articular  Rheumatism . . .  . 

Chronic  Otitis  Media 

Pregnancy 

Childbirth 

Abortion 

Exophthalmic  Goiter 

Malignant  Timior 

Chronic  Emphysema 

Empyema 

Imbecile 

Congenital  Malformation  of  Toe. 

Malaria 

Asthma 

Erysipelas 

Carbuncle 

Acute  Alcoholism 

Total 


1 

1 

1 

1 
26 
14 

6 

5 

1 

1 

3 

3 

1 

1 

1 

1 

1 

1 

i 

1 
1 
1 
1 
1 

75 

40.5% 


10 
15 
81 
2 
1 
1 
1 
1 
26 
14 
6 
5 
1 
1 
3 
3 
1 
1 
1 
1 
1 
1 
2 
1 
1 
1 
1 
1 
1 

185 

100% 


198  HOSPITAL   COMMITTEE 

TABLE  XLIII. 

Bellevue  Hospital. 

Aliens  Admitted  from  May  19,  1913,  to  June  18,  1913,  as  Public  Charges  Whose 

Causes  of  Dependence  Probably  Could  Have  Been  Detected  With  Proper 

Facilities  at  the  Time  of  Landing  in  the  United  States. 

This  table  represents  those  patients  among  the  iS£  cases  that  were  public  charges  front  causes 
existing  prior  to  landiyig  slwion  in  Table  XLII,  whose  causes  of  dependence  could  probably 
have  been  detected  had  adequate  facilities  existed  for  their  thorough  examination  at  the  time  of 
landing. 

These  cases  are  arranged  according  to  conditions  attending  the  landing  of  the  patients  in 
this  country  to  which  the  failure  to  prevent  their  presence  as  subsequent  public  cluirges  may 
reasonably  be  attributed. 


conditions  which  may  have  been  responsible 

FOR    the     failure    IN    PREVENTING   PUBLIC   DEPENDENCE. 

Number  of 
patients 

(1)  Lack  of  a  quiet  place  for  the  examination  of  heart  and  lungs, 

and  lack  of  facilities  for  undressing  immigrants 40 

(2)  Lack  of  medical  interpreters  and  lack  of  facilities  for  detain- 

ing mental  suspects 40 

(3)  Lack  of  place  in  which  to  properly  examine  discharged  seamen        5 

(4)  Lack  of  oversight  by  the  immigration  authorities  of  ships' 

crews  and  the  ease  of  desertion 6 

(5)  Difficulty  of  detecting  cases  of  epilepsy 2 

(6)  Appearance  possibly  trivial  at  entry   (case    of   congenital 

malformation  of  toe) 1 

(7)  Transfer  of  one  patient  for  childbirth  from  a  private  hospital 

before  technically  landed 1 

(8)  Apparent  carelessness  on  part  of  medical  examiners 10 

Total 105 


The  above  105  cases  were  composed  as  follows: 
Mandatorily  excludable, 

Insane 28 

Venereal  Diseases  (active  stage) 15 

Pulmonary  Tuberculosis 8 

Epilepsy 2 

Imbeciles 2        55 

Certifiable  as  "affecting  ability  to  earn  a  living  " 48 

Appearance  possibly  trivial  at  entry 1 

Public  charge  before  technically  landed 1 

105 


ALIENS  AND   NON-RESIDENTS 


igg 


TABLE  XLIV. 

AlienSjINon-Residents,  and  State  Poor  Removed  from  New  York  City  Institutions 
I'BY  THE  State  Board  of  Charities  in  the  Year  Ended  September  30,  1912. 

Key:  S.B.  C.  Removed  by  Stale  Board  of  Charities. 

U.S.  Removed  by  United  Slates  Immigration  Service. 

To  C.  Removed  to  other  Countries. 

To  S.  Removed  to  other  States. 

B.D.A.  Bureau  of  Dependent  Adults. 


Per  Cent. 
S.B.C.  S.B.C.  U.S.    Total  Total        of      '  Class     Class 
To  S.  To  C.  To  C.  To  C.     Re-      Grand    Total  Per  Cent, 
moved    Total 


Department  of  Public 
Charities: 

Metropolitan  Hospital 129  157 

City  Hospital Ill  103 

City  Home,  Manhattan ....  67  86 

Randalls  Idand 1  3 

B.D.A.  Manhattan 5  0 

Municipal  Lodging  House. . .  79  50 

Kings  County  Hospital 16  20 

Cumberland  Street  Hospital .  3  0 

City  Home,  Brooklyn 2  6 

B.D.A.  Brooklyn 0  8 

Bellevue  and  Allied 
Hospitals: 

Bellevue  Hospital 112  83 

Gouverneur  Hospital 6  15 

Pordham  Hospital 0  5 

Harlem  Hospital 4  0 

Department  of  Health; 

Riverside  Hospital 0  7 

Willard  Parker  Hospital 0  2 

State  Institutions: 

Central  Islip 0  14 

Manhattan  State  Hospital . .  0  6 

Private  Institutions: 

1.  Hospitals 34  63 

2.  Homes 17  12 

3.  Societies 28  21 

4.  Dispensaries 2  1 

Unknown  Institutions 5  26 

Total 621  688 


3 

170 

299 

22.0 

8 

111 

222 

16.4 

8 

94 

161 

11.9 

0 

3 

4 

0.3 

0 

0 

5 

0.4 

0 

50 

129 

9.5 

2 

22 

38 

2.9 

0 

0 

3 

0.2 

0 

6 

8 

0.6 

0 

8 

8 

0.6 

877 

7 

90 

202 

14.9 

0 

15 

21 

1.5 

0 

5 

5 

0.4 

0 

0 

4 

0.3 

232 

0 

7 

7 

0.5 

0 

2 

2 

0.2 

9 

0 

14 

14 

1.1 

1 

7 

7 

0.5 

21 

3 

66 

100 

7.4 

2 

14 

31 

2.3 

0 

21 

49 

3.6 

0 

1 

3 

0.2 

183 

0 

26 

31 

2.3 

31 

14 

732 

1,353 

100.0 

64.8 


17.1 


0.7 


13.5 
2.3 


)  HOSPITAL   COMMITTEE 

TABLE  XLV. 

Department  of  Public  Charities. 

Aliens,  Non-Residents,  and  State  Poor  Reported  Upon  by  the  Bureaus 
OF  Dependent  Adults,  Manhattan. 


Committed  to  City 

Home, 

Manhattan 

state  POOR 

&LIENS 

1,069 

974 

263 

92 

111 

2,005 

206 

1,203 

293 

1,256 

772 

1,556 

693 

1,462 

Returned  to  Commissioner 
of  Immigration 


1902. 
1903. 
1904. 
1905. 
1906. 
1907. 
1908. 
1909. 
1910. 
1911. 
1912. 


1,137 
861 
328 


TABLE  XLVI. 
State  Poor  in  State  Almshouses  in  New  York  City. 


Year 

Ending 

City  Home,  Brooklyn 

City  Home,  U 
Number 

Manhattan 

Number 

Whole 

Whole 

September  30 

Committed 

Number 

Committed 

Number 

During  Year 

Supported 

During  Year 

Supported 

1902. 

681 

710 

634 

634 

1903. 

66 

72 

933 

970 

1904. 

40 

46 

532 

562 

1905. 

48 

53 

126 

134 

1906. 

47 

49 

137 

137 

1907. 

56 

62 

198 

200 

1908. 

20 

21 

234 

241 

1909* 

1910. 

44 

44 

164 

166 

1911. 

20 

21 

203 

204 

*  The  figures  for  this  year  were  not  pubhshed  in  the  Annual  Report  of  the  State  Board 
of  Charities. 


ALIENS  AND   NON-RESIDENTS  201 

TABLE  XLVII. 

State  Board  of  Charities. 

Disbursements  of  the  Department  of  State  and  Alien  Poor  for  Salaries  and 
FOR  the  State  Poor. 


Per  Cent. 

Salaries      Maintenance  Maintenance  of  Main-  Removals  of 

Paid         of  State  Poor  of  State  Poor  tenance    State  Poor  from 

to  Staff     in  Entire  State  in  N.  Y.  City  Paid  to  Entire  State 

N.  Y.  City 

1902 §11,572.50      $12,913.82  85,516,44  43.0  19,062.54 

1903 12,800.00        13,068.17  5,149.64  39.0  7,627.20 

1904 12,937.74        11,236.55  3,971.78  36.0  5,259.39 

1905 11,297.88          8,596.26  1,289.63  15.0  2,338.57 

1906 13,373.67          8,678.89  890.17  10.0  4,369.67 

1907 11,879.39          8,446.65  1,118.20  13.0  2,248.16 

1908 13,478.64          8,913.86  1,268.93  14.0  3,179.76 

1909 14,940.00          7,261.21  890.70  12.0  1,595.36 

1910 17,060.00          6,043.67  1,107.50  18.0  1,923.49 

1911 19,614.16          5,227.01  724.82  14.0  2,816.36 

1912 28,060.00         *  603.79  ....  * 


'  Not  yet  itemized  in  report  of  State  Board  of  Charities. 


TABLE  XLVIIL 
Removals  of  State  Poor  from  New  York  State  by  the  State  Board  of  Charities. 


From  Entire 

From 

Prom  City 

From 

City  Homes, 

State,  Including  City  Home, 

Home,  Man- 

Both City 

Per  Cent. 

New  York  City 

Flatbush 

hattan 

Homes 

of  State 

1902 

931 

310 

458 

768 

82.0 

1903 

809 

14 

653 

667 

82.0 

1904 

496 

17 

335 

352 

71.0 

1905 

235 

17 

83 

100 

42.0 

1906 

256 

10 

101 

111 

43.0 

1907 

276 

19 

132 

151 

55.0 

1908 

280 

10 

117 

127 

45.0 

1909 

292 

not  given 

not  given 

not  given 

1910 

219 

15 

93 

108 

49.6 

1911 

Total  (Omit- 

300 

11 

112 

123 

41.0 

ting  1909).. 

3,802 

423 

2,084 

2,507 

66.0 

1,069 

634 

435 

974 

933 

41 

263 

532 

269 

92 

126 

34 

111 

137 

26 

2,005 

19S 

1,807 

206 

234 

28 

293 

not  given 

772 

164 

608 

693 

203 

490 

202  HOSPITAL   COMMITTEE 

TABLE  XLIX. 

COMraTMENTS   OF   STATE   POOR   TO   THE   CiTY   HOME,    MANHATTAN. 

Key:  B.D.A.    Bureau  of  Dependent  Adults,  Manhattan. 
S.B.C.      Slate  Board  of  Charities. 

Excess  B.D.A.    Excess  S.B.C. 
B.D.A.  Report   S.B.C.  Report  over  over 

S.B.C.  Report   B.D.A.  Report 

1902 

1903 

1904 

1905 

1906 

1907 

1908 

1909 

1910 

1911 

Total  (Omitting  1909) . .  6,185  3,161 

TABLE  L. 

New  York  City  Home,  Manhattan. 

Disposition  of  Alleged  State  Poor  Entered  on  the  State  Register  from  October  i,  iQii,  to 
September  30,  IQI2. 

Removed  to  other  countries 7 

Removed  to  other  states 78 

Discharged  to  "care  of  self" 36 

Discharged  as  not  proper  State  cases 51 

Discharged  as  otherwise  provided  for 6 

Returned  to  sliip 1 

Disposition  unknown 1 

Absconded 1 

Tsi 

TABLE  LL 
State  Poor  Maintained  in  the  New  York  City  Home,  Manh.attan. 

S.B.C.         D.P.C.  Average        D.P.C.     *Estimated  Estimated  Estimated 

Report         Report  Days          Report        Current       Current       Current 

Number        S.B.C.  Stay          Number      Expense       Loss  to        Gain  to 

Maintained  Payment  Per  Case  Maintained    to  City          Citj'            City 

1902 634  $2,623.22  12  1,069  S3,861.23  $1,238.01     

1903 970  4,143.92  12  1,028  3,821.69     S322.23 

1904 562  3,241.78  16  344  1,892.82     1,348.96 

1905 134  867.49  18  100  610.38     257.11 

1906 137  524.10  11  111  457.00     67.10 

1907 200  778.92  11  2,007  8,420.17  7,641.25     

1908 241  1,126.79  13  213  981.89     144.90 

1909 not  given  890.70  295  

1910 166  874.64  15  774  4,906.39  4,031.75     

1911 204  620.54  8  694  2,285.20  1,664.66     


$15,692.10  314,575.67    S2,140.30 

2,140.30 
Total  Net  Current  Loss  to  City S12.435.37 

Ratio  of  Total  Net  Current  Loss  to  Total  Payments,  73  to  100. 

*  Estimated  on  average  days  stay  for  cases  paid  for  by  the  State  Board  of  Charities 
and  the  Department  of  Charities'  per  capita  per  diem  for  dependent  expense  (including 
administration  and  general  current  expenses)  for  each  year.  Corporate  stock  expenditures 
are  not  included. 


ALIENS  AND   NON-RESIDENTS  203 

TABLE  LII. 

Institutions  Harboring  the  State  Poor  Entered  on  the  State  Register  at  the 

New  York  City  Home,  Manhattan,  for  Whom  Bills  Were  Rendered  to  the 

State  Board  of  Charities,  from  Oct.  1,  1911,  to  Sept.  30,  1912. 

City  Home 35 

Municipal  Lodging  House 11 

City  Hospital 37 

Metropolitan  Hospital 28 

Bellevue  Hospital 2 

Misericordia  Hospital 1 

Society  for  Prevention  of  Cruelty  to  Children 1 

Unknown 11 

126 


TABLE  LIII. 

New  York  City  Home,  Manhattan. 

Disposition  of  Alleged  Aliens,  Non-Residents,  and  State  Poor  Reported  by  the  Bureau  of 
Dependent  Adults,  Manhattan,  to  the  State  Board  of  Charities  in  iqi2. 

Deported  to  other  countries 19 

Removed  to  other  states 24 

Discharged  to  State  Agent 39 

Discharged  by  order  of  State  Agent 15 

Discharged  with  no  reason  given 11 

Returned  to  ship 1 

Died 1 

Still  in  Home  January  8,  1913 4 

Not  on  the  Register  at  the  City  Home 19 

133 


TABLE  LIV. 

Metropolitan  Hospital. 

Deportation  Cases  in  1911. 

{From  iQii  Annual  Report  of  the  Department  of  Public  Charities.) 

Remaining  January  1,  1911 150 

Admitted  during  Year  1911 1,434       1,584 

Discharged  during  Year  1911 1,073 

Deported  during  Year  1911 269 

Died  during  Year  1911 92 

Transferred  to  City  Home 2 

Transferred  to  Bellevue  Hospital 2 

Eloped 1 

Remaining  December  31,  1911 145       1,584 

Discharged  cases  were  four  times  the  number  deported. 

Excluding  those  who  died,  only  18%  of  the  deportable  cases  were  deported. 


204  HOSPITAL  COMMITTEE 

TABLE  LV. 

Department  of  Public  Charities. 

Dependents  Reported  by  Bureaus  of  Dependent  Adults. 

Removals  by  the  State  Board  of  Charities  and  the  United  States  Government. 

BROOKLYN   bureau. 


Reported  to       Removed  by  Percentage 

S.B.C.  S.B.C.  Removed  of  Reported 


1906 

1907 

190S 

1909 

1910 

1911 

Total 961  399  41 


98 

41 

42 

161 

41 

25 

204 

147 

72 

178 

22 

12 

195 

76 

31 

125 

72 

58 

APPENDIX 

TO 

ALIENS,  NON-RESIDENTS,  AND  STATE  POOR. 

Patients  Admitted  to  Bellevue  Hospital 
FROM  May  19  to  June  18,  1913 

The  following  digests  are  from  the  histories  of  alien  patients  admitted 
to  Bellevue  Hospital  during  a  period  of  31  days.  These  histories  were  clas- 
sified after  physical  examination  and  investigation  of  the  patients  and  medi- 
cal records  by  the  physicians  and  investigators  in  the  service  of  the  Com- 
mittee. 

The  classification  separates  aliens  from  all  other  patients,  and  the  aliens 
are  further  subdivided  into : 

Class  I-i.    Aliens  in  the  United  States  in  violation  of  the  Federal  Immigration  Law. 
Class  I-2.    Aliens   deportable  under  the  Federal   Immigration  Law. 
Class  I-3.    Aliens    deportable   under   the   State   Charities   Law : 

a.  From  causes   existing  prior   to  landing. 

b.  From  causes  whose  priority  to  landing  is  not  certain. 

c.  From  causes   existing  subsequent  to  landing. 

Class  I-4.    Aliens  deportable   (with  consent)   under  the  State  Insanity  Law: 

a.  From   causes   existing  prior  to  landing. 

b.  From  causes   whose  priority  to  landing  is  not  certain. 

c.  From  causes  existing  subsequent  to  landing. 
Class  I-s.    Aliens  whose  deportation  might  not  have  been  humane: 

a.  Likely  to   become  chronic   or   recurrent   dependents. 

b.  Seemingly  temporary  dependents. 

CLASS  I — I.    Aliens  in  the  United  States  in  Violation  of  the  Federal 
Immigration  Law. 

Case  i.    A  native  of  Austria.    Age  24  years.    A  single  man. 

This  patient  was  a  deserted  seaman,  in  New  York  City  only  25^  months,  and  previ- 
ously had  resided  4  years  in  Philadelphia.  He  was  employed  in  a  factory,  and  also 
had  taken  positions  as  a  waiter  in  restaurants.  He  was  suffering  from  chronic  pul- 
monary tuberculosis,  with  a  history  of  existing  conditions  prior  to  admission  to  the 
United  States.    The  prognosis  was  unfavorable. 

Case  2.    A  native  of  Italy.     Age  24  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1912.  She  was  a  prostitute.  She  was  ad- 
mitted to  the  Hospital  for  psychopathic  observation  and  was  deported  by  the  United 
States  Immigration  Service. 

Case  3.     A  native  of  Hungary.    Age  22  years. 

This  patient  claimed  to  be  a  divorced  woman.  She  landed  at  New  York  in  Au- 
gust, 1911.  She  was  suffering  from  venereal  disease  of  3  years  existence,  and 
had  been  admitted  to  the  same  Hospital  in  the  preceding  month.  She  was  a  resi- 
dent of  New  York  only  454  months,  and  previously  had  lived  in  Chicago.  Her 
parents  were  living  in  Europe,  but  she  was  without  relatives  in  this  country.  The 
prognosis  was  unfavorable. 

Case  4.     A  native  of  England.     Age  39  years.     A  married  man.     A  seaman. 

This  patient  landed  at  New  York  in  1900,  and  had  been  engaged  as  a  porter 
after  landing.  He  was  suffering  from  suppurative  pleurisy.  He  had  an  operation  in 
another  hospital  the  same  month  he  was  admitted  to  Bellevue  Hospital.  He  earned 
$50  a  month  when  working,  but  had  been  unemployed  for  7  weeks  prior  to  admis- 
sion. A  wife  and  6  children  were  dependent  upon  him.  The  prognosis  was 
unfavorable. 

205 


206  HOSPITAL   COMMITTEE 

Case  5.     A  native  of  Austria.    Age  20  years.    A  single  man. 

This  patient  landed  at  New  York  in  March,  1913.  He  was  suffering  from  chronic 
cardiac  valvular  disease  and  acute  multiple  arthritis,  with  history  of  cardiac  disease 
and  gonorrheal  infection  prior  to  landing.  He  was  a  deserted  seaman  who  had  taken 
up  the  occupation  of  a  porter  on  shore.    The  prognosis  was  unfavorable. 

Case  6.    A  native  of  Austria.     Age  22  years.    A  single  man. 

This  patient  landed  at  New  York  in  March,  1910.  He  was  a  deserted  seaman, 
who  had  taken  up  the  occupation  of  a  railroad  employee.  Diagnosis,  facial  erysipelas. 
The  prognosis  was  favorable. 

Case  7.    A  native  of  Germany.    Age  62  years.    A  single  man. 

This  patient  landed  at  New  York  April  i,  1913.  Previous  to  his  arrival  in  the 
United  States  he  had  resided  in  Panama.  Six  weeks  after  landing  he  was  taken  ill 
and  was  admitted  to  the  Hospital.  After  admission  to  the  Hospital  he  was  trans- 
ferred to  the  psychopathic  observation  ward.  The  diagnosis  was  cerebro-spinal 
syphilis  and  general  paresis,  existing  prior  to  landing.  He  had  no  money  to  pay  for 
his  maintenance  at  the  Hospital,  and  also  had  no  relatives  in  this  country  who  could 
assist  him.  He  was  discharged  in  aa  unimproved  condition.  The  prognosis  was  un- 
favorable. 

Case  8.    A  native  of  Austria.    Age  27  years.    A  single  woman. 

This  patient  landed  September  2,  1912,  and  settled  in  New  York  City.  She  came 
to  the  Hospital  from  the  Coroner's  Office  as  a  prisoner.  She  had  murdered  her 
newly-born  child  and  attempted  to  commit  suicide.  From  the  medical  history  it  is  evi- 
dent that  this  patient  became  pregnant  prior  to  landing.  The  prognosis  was  un- 
favorable. 

Case  9.     A  native  of  Italy.    Age  24  years.    A  married  woman. 

This  patient  came  to  the  United  States  from  Canada  in  December,  191 1.  She  was 
admitted  to  the  Hospital  suffering  from  chronic  salpingitis,  and  was  discharged  in  an 
unimproved  condition.  The  medical  records  indicate  that  her  illness  began  3  years 
before.  Her  husband  was  a  saloon  keeper,  but  business  brought  in  very  little.  She 
had  worked  as  a  finisher  of  waists  when  not  ill.    The  prognosis  was  unfavorable. 

Case  10.    A  native  of  Turkey.    Age  25  years.    A  single  man. 

This  patient  landed  at  New  York  in  February,  1913.  About  4  months  thereafter 
he  had  a  hemorrhage  and  was  taken  to  the  Hospital.  The  diagnosis  was  chronic  pul- 
monary tuberculosis.  The  condition  of  his  lungs  indicated  that  he  had  had  this  dis- 
ease prior  to  landing.  He  had  no  savings,  and  his  brother,  the  only  relative  he 
had  in  this  City,  was  able  to  give  him  very  little  assistance.  The  prognosis  was 
unfavorable. 

Case  ii.    A  native  of  Argentine  Republic.    Age  26  years.    A  single  man. 

This  patient  landed  at  New  York  in  December,  1912.  His  medical  history  shows 
that  he  had  been  suffering  from  pulmonary  tuberculosis  prior  to  his  admission  to  the 
United  States.  The  diagnosis  of  his  illness  was  pulmonary  tuberculosis  and  manic 
depressive  insanity.  The  prognosis  was  unfavorable.  He  was  deported  by  the  United 
States  Immigration  Service. 

Case  12.     A  native  of  the  British  West  Indies.    Age  30  years.    A  single  man. 

This  patient  was  a  seaman,  who  deserted  his  vessel  in  May,  1913,  and  settled  in 
New  York  City,  in  violation  of  the  regulations  of  the  United  States  Department  of 
Labor.  His  medical  history  recorded  3  or  4  attacks  of  gonorrhea  prior  to  his  arrival 
in  the  United  States.  He  was  treated  at  the  Hospital  for  acute  bronchitis  and  was 
discharged  as  cured.  This  man  had  no  definite  occupation  and  no  savings.  The 
prognosis  was  unfavorable. 

Case  13.    A  native  of  British  West  Indies.    Age  23  years.    A  single  man. 

This  patient  was  a  seaman  who  deserted  at  Tampa,  Florida,  in  June,  1910,  thus 
gaining  admission  to  the  United  States  in  violation  of  the  regulations  of  the  United 
States  Department  of  Labor.  He  came  to  New  York  City  on  the  20th  of  June,  1912, 
and  was  employed  as  drill  man  in  the  subway.  His  medical  history  shows  that  he 
had  this  disease  prior  to  landing.  The  diagnosis  of  his  condition  was  systemic 
syphilis.  He  was  a  drinking  man,  who  spent  all  his  earnings.  He  had  been 
ill  off  and  on  for  over  a  year.  He  had  no  relatives  in  this  country.  His  parents  lived 
in  the  West  Indies.    The  prognosis  was  unfavorable. 


ALIENS  AND   NON-RESIDENTS  207 

Case  14.    A  native  of  England.    Age  30  years.    A  single  man. 

This  patient  was  a  seaman.  He  deserted  in  1907  and  took  up  his  residence  in 
New  York  City,  in  violation  of  the  regulations  of  the  United  States  Department  of 
Labor.  His  diagnosis  was  malnutrition,  and  his  general  condition  was  very  poor. 
On  admission  to  the  Hospital  he  had  had  a  carbuncle  of  18  weeks  existence.  He  had 
been  out  of  work  for  some  time  and  had  no  savings.  He  also  had  no  relatives  able 
to  assist  him.  As  he  was  in  need  of  a  prolonged  period  of  convalescent  care  he 
was  transferred  to  another  hospital.  The  prognosis  for  robust  health  was  un- 
favorable. 

Case  15.    A  native  of  England.     Age  20  years.    A  single  man. 

This  patient  was  a  seaman.  He  landed  at  New  York  May  31,  1913,  and  was  to 
sail  in  a  few  days.  On  June  2,  1913,  he  was  admitted  to  the  Hospital  suffering  from 
syphilis,  which  was  contracted  prior  to  his  arrival  in  the  United  States.  He  had  previ- 
ously been  admitted  to  the  same  Hospital  for  acute  gonorrhea.  The  prognosis  was 
unfavorable. 

Case  16.     A  native  of  Austria.    Age  17  years.    A  single  woman. 

This  patient  landed  at  New  York  May  25,  1913.  She  was  admitted  for  psycho- 
pathic observation  and  declared  insane.  The  medical  history  showed  that  this  con- 
dition existed  for  2  years  prior  to  landing.    The  prognosis  was  unfavorable. 

Case  17.    A  native  of  Italy.    Age  34  years.    A  married  man. 

This  patient  landed  at  New  York  October  17,  1912.  The  medical  history  shows 
that  he  had  a  case  of  incipient  pulmonary  tuberculosis  of  7  months  existence.  After 
a  short  stay  in  the  general  medical  ward  he  was  transferred  to  the  psychopathic 
ward  for  observation,  and  his  case  was  diagnosed  as  allied  to  manic  depressive  in- 
sanity. He  was  discharged  in  the  care  of  his  mother-in-law,  who,  however,  could 
not  pay  for  his  maintenance  at  the  Hospital.  This  man  had  a  wife  and  2  dependent 
children  in  Italy,  who  were  to  join  him  here  in  the  fall.  The  prognosis  was  unfavora- 
ble. 
Case  18.    A  native  of  Austria.    Age  40  years. 

This  patient  landed  at  New  York  in  1910.  He  was  admitted  for  psychopathic 
observation.  The  diagnosis  in  this  case  was  psychopathic  disorder,  existing  prior  to 
landing.  He  was  deported  on  June  17,  1913,  by  the  United  States  Immigration  Serv- 
ice. 

Case  19.    A  native  of  England.    Age  26  years.    A  married  man. 

This  patient  was  employed  as  cook  on  a  steamship.  He  came  to  New  York  June 
6,  1913,  and  was  admitted  to  the  Hospital  by  ambulance  June  7,  1913.  He  was  suffer- 
ing from  venereal  infection  of  at  least  10  days  existence.  He  had  no  savings  and 
could  not  pay  for  his  maintenance  at  the  Hospital.    The  prognosis  was  unfavorable. 

Case  20.     A  native  of  Cuba.    Age  20  years.    A  single  man. 

This  patient  landed  at  New  York  in  May,  1912.  His  medical  history  shows  that 
he  had  syphilis  contracted  3  years  prior  to  landing.  He  was  admitted  to  the  Hospital 
to  be  treated  for  acute  gonorrhea  of  3  weeks  standing.  His  parents  were  in  Europe 
and  he  was  alone  in  this  country.  He  earned  about  $8.00  a  week  when  working  and 
at  the  time  of  admission  had  no  savings.    The  prognosis  was  unfavorable. 

Case  21.    A  native  of  Austria.    Age  35  years.    A  single  man. 

This  patient  landed  at  New  York  March  11,  1911.  He  was  admitted  to  the  Hos- 
pital to  be  treated  for  shock  and  internal  injury  which  he  sustained  in  an  accident. 
His  medical  history  revealed  a  case  of  pulmonary  tuberculosis,  which  condition  ex- 
isted prior  to  landing.  He  had  no  relatives  in  the  United  States  and  had  no  savings. 
He  had  earned  about  $4.00  a  week.     The  prognosis  was  unfavorable. 

Case  22.    A  native  of  Austria.    Age  20  years.    A  single  man. 

This  patient  landed  at  New  York  March  2,  1913,  and  lived  i  month  thereafter  in 
New  Jersey.  His  medical  history  showed  an  attack  of  gonorrhea  6  months  prior  to 
landing  in  the  United  States.  He  was  admitted  to  the  Hospital  suffering  from  sub- 
acute arthritis,  probably  gonorrheal  in  origin.  He  was  also  a  chronic  valvular  car- 
diac patient.  This  was  his  second  admission  to  Bellevue  Hospital.  When  able,  he  had 
worked  as  a  porter  in  a  saloon,  earning  $2.00  per  week.  His  relatives  were  in  Europe. 
He  had  no  savings.     The  prognosis  was  unfavorable. 


2o8  HOSPITAL   COMMITTEE 

Case  23.     A  native  of  Italy.    Age  28  years.     A  married  man. 

This  patient  landed   at   New   York   February  8,    1912.     He   was   suffering  from 
chronic  pulmonary  tuberculosis,   which  condition  existed  prior  to  landing.     He  was 
transferred  to  a  chronic  hospital.     He  had  no  savings  and  had  a  wife  dependent  on 
him.    The  prognosis  was  unfavorable. 
Case  24.     A  native  of  Ireland.     Age  43  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1913.  Her  medical  history  shows  that  she 
had  delusions  of  persecution  on  board  of  ship  and  in  her  native  country.  She  had 
been  confined  as  insane  in  a  hospital  abroad.  The  diagnosis  in  this  case  was  allied 
to  manic  depressive  insanity,  from  causes  existing  prior  to  landing.  The  prognosis 
was  unfavorable. 

Case  25.     A  native  of  Italy.     Age  26  years.     A  married  man. 

This  patient  landed  at  New  York  May  29,  191 1,  and  settled  in  Jersey  City,  N.  J. 
On  June  11,  1913,  he  came  to  this  City  to  be  admitted  to  the  Hospital.  After  3  or  4 
weeks  of  treatment  at  the  dispensary  the  medical  history  records  a  chancre,  which 
he  contracted  zYz  years  ago,  prior  to  landing.  The  diagnosis  on  discharge  was 
general  systemic  syphilis.  This  man  was  a  laborer,  earning  $g.oo  a  week.  From  this 
sum  he  sent  an  allowance  to  his  wife  and  mother  in  Europe.  He  had  no  savings  at 
the  time  of  admission  to  the  Hospital.    The  prognosis  was  unfavorable. 

Case  26.    A  native  of  Italy.    Age  24  years.    A  married  woman. 

This  patient  landed  at  New  York  in  September,  1910.  Her  family  history  showed 
that  her  mother  died  of  chronic  bronchitis  and  2  sisters  of  tuberculosis.  The  patient 
was  suffering  from  chronic  pulmonary  tuberculosis  contracted  prior  to  landing.  She 
was  transferred  to  a  chronic  hospital.  Her  husband  earned  but  little  and  had  2  chil- 
dren dependent  upon  him.    The  prognosis  was  unfavorable. 

Case  27.     A  native  of  England.     Age  18  years.    A  single  man. 

This  patient  landed  at  New  York  April  30,  1911.  He  was  admitted  to  the  Hos- 
pital to  be  treated  for  an  abscess  of  the  foot.  His  medical  history  showed  that  he 
had  a  like  abscess  6  years  ago.  He  also  had  pulmonary  tuberculosis,  existing  prior 
to  landing.  He  had  no  parents  in  the  United  States.  He  was  employed  as  an  iron 
worker  and  earned  about  $6.00  a  week.  The  only  relative  he  had  in  this  City  was  a 
married  sister.     The  prognosis  was  unfavorable. 

Case  28.     A  native  of  Germany.    Age  31  years.    A  single  man. 

This  patient  landed  at  New  York  June  9,  1913,  and  took  up  his  residence  with  his 
brother.  After  3  days  here  he  attempted  to  commit  suicide  by  inhaling  gas.  His 
medical  history  was  one  of  gas  poisoning  followed  by  convulsions.  His  diagnosis  was 
also  epilepsy.    The  prognosis  was  unfavorable. 

Case  29.    A  native  of  Hungary.    Age  36  years.    A  married  woman. 

This  patient  landed  at  New  York  in  June,  1912.  Nine  years  prior  to  landing  she 
contracted  syphilis,  for  which  she  was  treated  for  3  weeks.  Her  diagnosis  was 
systemic  syphilis  and  emphysema.  Her  heart  was  also  in  poor  condition.  Prior  to 
admission  she  had  been  ill  6  months.  She  had  previously  been  a  patient  in  Bellevue 
Hospital.  Her  husband,  a  porter,  barely  made  a  living.  This  patient  died  in  the 
hospital  on  June  17,  1913. 

Case  30.    A  native  of  Turkey.    Age  19  years.    A  single  man. 

This  patient  landed  at  New  York  December  15,  1912.  His  medical  history  shows 
that  he  had  had  a  cough  for  16  years.  Prior  to  being  admitted  to  Bellevue  Hospital 
he  was  treated  at  a  private  hospital.  His  diagnosis  was  chronic  pulmonary  tubercu- 
losis, which  developed  prior  to  landing.  He  had  had  hemorrhages  for  10  weeks 
and  had  been  unable  to  work.  He  had  earned  about  $8.00  a  week.  He  was  all 
alone  in  this  country  and  had  no  savings.  He  was  transferred  to  a  tuberculosis  hos- 
pital.   The  prognosis  was  unfavorable. 

Case  31.     A  native  of  Italy.     Age  27  years.    A  single  woman. 

This  patient  landed  at  New  York  October  8,  1912,  and  settled  in  New  York  State 
outside  of  the  City,  where  she  was  employed  as  cook  b}-  a  private  familj-.  She  came 
to  New  York  in  June,  1913,  and  was  admitted  to  the  Hospital  awaiting  parturition. 
Her  medical  history  indicates  pregnancy  prior  to  landing;  otherwise  her  health  was 
in  good  condition.  She  had  no  relative  in  this  country.  After  recovery  from  child- 
birth this  patient  was  discharged  into  the  custody  of  officials  of  the  United  States 
Immigration  Service. 


ALIENS  AND   NON-RESIDENTS  209 

Case  32.    A  native  of  Austria.    Age  62  years.    A  widow. 

This  patient  landed  at  New  York  April  i,  1913.  She  was  admitted  to  the  psycho- 
pathic ward  for  observation.  The  diagnosis  was  senile  dementia,  prior  to  landing. 
This  woman  was  an  inmate  of  an  institution  in  Europe,  and  was  assisted  in  coming 
to  the  United  States  by  her  countrymen.  She  was  transferred  to  a  State  hospital  for 
the  insane.  Her  case  was  taken  up  by  the  United  States  Immigration  Service  and  a 
warrant  for  her  deportation  was  said  to  have  been  issued. 

Case  33.    A  native  of  Italy.    Age  37  years.    A  widow. 

This  patient  landed  at  New  York  in  November,  igo6.  Her  family  history  shows 
that  her  husband  had  died  of  tuberculosis  and  that  2  of  her  children  suffered  from 
convulsions.  The  patient  herself  had  suffered  from  epileptic  seizures  for  10  years. 
She  was  also  a  chronic  cardiac.  This  woman  had  4  children,  3  of  whom  were  de- 
pendent upon  her  for  support.  One  girl,  17  years  old,  worked  in  a  factory.  She  had 
no  savings  at  the  time  of  admission  to  the  Hospitah     The  prognosis  was  unfavorable. 

Case  34.     A  native  of  Germany.     Age  20  years.    A  single  man. 

This  patient  was  a  seaman,  who  deserted  in  igii  and  took  a  position  as  a  baker 
in  New  York  City,  in  violation  of  the  rules  and  regulations  of  the  United  States 
Department  of  Labor.  He  was  admitted  to  the  Hospital  to  be  treated  for  a  fracture 
from  a  fall.  He  was  unable  to  pay  for  his  maintenance  at  the  Hospital.  The  prog- 
nosis was  favorable. 

Case  35.     A  native  of  Italy.     Age  24  years.    A  married  woman. 

This  patient  landed  at  New  York  May  25,  1912.  Her  mother  was  a  neurotic. 
She  herself  had  always  been  nervous.  She  was  admitted  to  the  psychopathic  ward 
for  observation  and  transferred  as  insane  to  a  State  hospital.  Her  case  was  referred 
to  the  United  States  Immigration  Service  for  deportation. 

Case  36.     A  native  of  Russia.    Age  39  years.    A  married  man. 

This  patient  landed  at  New  Orleans  May  i,  1913.  He  was  a  deserted  seaman, 
who  landed  and  assumed  another  occupation,  in  violation  of  the  rules  and  regulations 
of  the  United  States  Department  of  Labor.  On  June  13,  1913,  he  came  to  New 
York  City,  and  2  days  thereafter  was  taken  to  the  Hospital  by  ambulance.  His 
medical  history  showed  that  he  was  a  chronic  alcoholic.  The  prognosis  was  un- 
favorable. 

Case  37.     A  native  of  Austria.     Age  16  years.     A  girl. 

This  patient  landed  at  Philadelphia  in  November,  1912.  She  came  to  New  York 
June  7,  1913,  and  was  admitted  to  the  Hospital  June  isth.  Her  medical  history  shows 
that  she  had  always  been  anemic,  never  menstruated,  and  had  pulmonary  tuberculosis 
of  I  year's  standing.  She  had  been  working  as  a  dressmaker  and  earned  about 
$6.00  a  week.  Her  parents  were  in  Austria.  She  had  no  relatives  able  to  assist  her. 
She  had  no  savings  at  the  time  of  admission  to  the  Hospital.  The  prognosis  was  un- 
favorable. 

Case  38.    A  native  of  Turkey.     Age  19  years.    A  single  man. 

This  patient  was  a  seaman.  He  deserted  in  January,  1912,  and  settled  in  New 
York  City  and  assumed  another  occupation,  in  violation  of  the  rules  and  regulations  of 
the  United  States  Department  of  Labor.  His  medical  history  showed  that  he  con- 
tracted syphilis  in  Europe.  The  diagnosis  was  acute  secondary  syphilis.  The  prog- 
nosis was  unfavorable. 

Case  39.     A  native  of  Italy.     Age  33  years.    A  widow. 

This  patient  was  admitted  to  the  United  States  October  14,  1912,  after  two  hear- 
ings before  the  Board  of  Special  Inquiry  held  upon  the  ground  that  she  might  be- 
come a  public  charge.  The  diagnosis  was  syphilis  of  the  nose  and  throat  Her  medi- 
cal history  suggested  a  psychosis  of  paranoid  type.  She  was  mentally  unstable  prior 
to  landing.  She  had  3  children  living  in  Italy;  I  was  17  years  of  age,  but  2  were 
dependent  upon  her  for  support.  At  the  time  of  admission  to  the  Hospital  she  had 
no  savings.  She  was  discharged  at  her  own  risk  in  an  unimproved  condition.  The 
prognosis  was  unfavorable. 

Case  40.    A  native  of  Ireland.    Age  21  years.    A  married  man. 

This  patient  was  a  seaman  who  had  been  sick  in  the  ship's  hospital  2  days  prior 
to  admission  to  Bellevue  by  ambulance.    His  condition  was  diagnosed  as  acute  gonor- 


2IO  HOSPITAL   COMMITTEE 

rhea.      This    was    contracted    abroad.      He    was    deported    by    the    State    Board    of 
Charities. 

CLASS  1-2.     Aliens  Deportable   Under  the  Federal  Immigration  Law. 

Case  i.    A  native  of  Turkey.    Age  22  years.    A  married  woman. 

This  patient  landed  at  New  York  in  July,  191 1.  She  was  suffering  from  chronic 
salpingitis,  oophoritis,  and  stenosis  of  cervix  and  uterus,  with  history  prior  to  land- 
ing. She  was  dependent  upon  a  husband  earning  $8.00  to  $9.00  a  week,  and  irregu- 
larly employed.  They  had  no  savings.  The  prognosis  was  unfavorable.  In  all  proba- 
bility she  will  be  a  chronic  invalid. 

Case  2.     A  native  of  Germany.    Age  28  years.    A  married  man. 

This  patient  landed  at  New  York  in  February,  1913.  He  had  been  in  New  York 
City  2  weeks,  previously  in  Connecticut.  His  wife,  child,  and  parents  lived  in  Ger- 
many. He  was  suffering  from  rheumatism,  with  history  of  3  attacks  of  contributing 
gonorrheal  infection  in  the  years  of  1906,  1908,  and  1909.  Prognosis  for  freedom 
from  subsequent  attacks  unfavorable. 

Case  3.    A  native  of  Germany.    Age  35  years.    A  married  man. 

This  patient  landed  at  New  York  in  October,  1912.  He  was  suffering  from 
chronic  otitis  media,  with  history  prior  to  landing.  He  had  a  wife  and  4  young  chil- 
dren in  Germany,  and  was  in  debt.  The  prognosis  for  recovery  was  unfavorable  and 
indicated  a  recurrent  dependence. 

Case  4.     A  native  of  Australia.    Age  20  years.    A  single  man. 

This  patient  landed  at  New  York  in  April,  1913,  and  within  17  days  was  a  patient 
in  the  Hospital.  He  was  suffering  from  chronic  cardiac  valvular  disease  of  s  or  6 
years  existence.  He  had  been  unable  to  work  for  2  years  prior  to  landing.  He  was 
admitted  to  Bellevue  twice  in  his  3  weeks  stay  in  this  country.  The  prognosis  for 
recovery  was  unfavorable. 

Case  5.    A  native  of  Italy.    Age  19  years.    A  single  man. 

This  patient  landed  at  New  York  in  June,  1912.  He  was  suffering  from  chronic 
cardiac  valvular  disease,  with  history  prior  to  landing,  complicated  with  malaria.  The 
prognosis  was  unfavorable  and  indicated  recurrent  or  chronic  dependence. 

Case  6.    A  native  of  Italy.    Age  24  years.    A  single  woman. 

This  patient  landed  at  New  York  in  September,  1912.  She  had  an  illegitimate 
child  zyi  years  old  in  Italy.  She  was  a  patient  in  the  Hospital  for  miscarriage.  She 
also  had  pulmonary  tuberculosis  and  a  history  of  mental  inferiority.  The  prognosis 
was  unfavorable. 

Case  7.    A  native  of  Greece.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  in  June,  1910.  He  was  suffering  from  chronic 
venereal  disease,  also  from  inguinal  hernia,  with  history  of  6  years  existence.  He  had 
earned  $7.00  per  week  when  employed.    The  prognosis  was  unfavorable. 

Case  8.     A  native  of  Russia.     Age  33  years.     A  married  man. 

This  patient  landed  at  New  York  in  December,  1910.  He  was  suffering  from 
multiple  arthritis  and  chronic  pleurisy.  He  had  been  in  a  hospital  in  Europe  6  years 
before  with  arthritis.  He  had  a  wife  and  3  small  children  in  Russia  dependent  upon 
him.    The  prognosis  was  unfavorable. 

Case  9.    A  native  of  Russia.    Age  40  years.    A  married  woman. 

This  patient  landed  at  New  York  in  July,  1910.  She  was  in  the  Hospital  for 
psychopathic  observation,  and  was  committed  to  a  State  hospital  for  insane.  The  his- 
tory showed  that  the  underlying  conditions  existed  before  landing  in  the  United 
States.    The  prognosis  was  unfavorable. 

Case  10.    A  native  of  Ireland.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  April  29,  1913.  He  was  admitted  to  the  Hos- 
pital about  3  weeks  afterward.  He  was  a  chronic  cardiac  and  also  had  acute  arthri- 
tis.   His  medical  history  showed  that  this  attack  of  arthritis  was  a  relapse.     He  was 


ALIENS  AND   NON-RESIDENTS  211 

an  unskilled  laborer.  He  had  no  relatives  in  this  country  and  had  no  savings  at  the 
time  of  admission  to  the  Hospital.    The  prognosis  was  unfavorable. 

Case  ii.    A  native  of  Ireland.    Age  23  years.    A  single  woman. 

This  patient  landed  at  New  York  February  19,  1910.  Her  medical  history  showed 
that  she  had  been  addicted  to  the  use  of  alcohol  and  had  had  rheumatic  fever  3 
years  prior  to  landing.  She  was  treated  at  the  time  in  a  hospital  in  Europe.  The 
diagnosis  of  her  condition  was  chronic  cardiac  disease  and  chronic  pericarditis.  This 
woman  had  worked  as  a  domestic.  She  had  no  savings  at  the  time  of  admission  to 
the  Hospital.  Her  mother  lived  in  Europe.  Her  sister,  the  only  relative  she  had  in 
this  country,  was  unable  to  assist  her.    The  prognosis  was  unfavorable. 

Case  12.    A  native  of  Jamaica.    Age  20  years.     A  single  man. 

This  patient  was  a  seaman,  discharged  in  New  York  City  February  28,  1913. 
Three  weeks  afterward  he  was  admitted  to  a  public  hospital,  where  he  stayed  9 
weeks.  He  was  then  admitted  to  Bellevue  Hospital.  His  medical  history  showed 
that  he  had  been  suffering  from  chronic  pulmonary  emphysema  and  had  had  acute 
respiratory  symptoms  of  4  months  existence.  He  was  eventually  deported  to  Jamaica 
by  the  State  Board  of  Charities.     The  prognosis  was  unfavorable. 

Case  13.    A  native  of  Russia.    Age  20  years.    A  single  man. 

This  patient  landed  at  New  York  in  December,  1912.  He  had  congenital  mal- 
formation of  the  toe.  He  was  discharged  in  an  unimproved  condition.  He  was 
a  shoemaker  and  had  been  out  of  work  for  2  months  prior  to  admission  to  the  Hos- 
pital. He  lived  with  his  parents,  but  they  were  unable  to  pay  for  his  maintenance  at 
the  Hospital.    The  prognosis  was  unfavorable. 

Case  14.    A  native  of  Italy.    Age  58  years.    A  married  man. 

This  patient  landed  at  Boston  in  May,  1913.  He  was  admitted  to  the  Hospital 
for  psychopathic  observation  and  was  transferred  as  insane  to  a  State  hospital.  His 
medical  history  recorded  that  he  had  been  "mentally  sick"  in  a  hospital  in  Italy  9 
years  before.  He  had  been  an  inmate  of  a  New  York  State  hospital  and  had  been  de- 
ported on  a  prior  occasion. 

Case  15.    A  native  of  Mexico.    Age  24  years.    A  married  man. 

This  patient  arrived  in  the  United  States  in  July,  1910.  He  had  settled  in  New 
Jersey  and  had  come  to  New  York  City  6  months  prior  to  admission  to  the  Hos- 
pital. His  medical  history  indicated  that  he  had  been  mentally  unbalanced  and  had 
acted  queerly  for  a  long  time,  and  that  the  causes  underlying  his  condition  existed 
prior  to  landing.    He  was  deported  at  the  expense  of  relatives  in  July,  1913. 

Case  16.    A  native  of  Russia.    Age  19  years.    A  single  woman. 

This  patient  landed  at  New  York  July  3,  1912.  She  was  admitted  to  the  Hospital 
for  psychopathic  observation  and  transferred  as  insane  to  a  State  hospital.  Her  his- 
tory indicated  that  the  causes  underlying  her  condition  existed  prior  to  landing. 

Case  17.     A  native  of  England.    Age  33  years.    A  married  man. 

This  patient  was  a  seaman,  discharged  in  New  York  May  23,  1913.  On  May  25, 
1913,  he  was  admitted  to  the  Hospital  to  be  treated  for  a  laceration  of  the  scalp  and 
alcoholism.  He  had  been  addicted  to  alcohol  prior  to  landing.  He  had  a  wife  and  2 
small  children  in  England  and  had  no  savings  at  the  time  of  admission  to  the  Hos- 
pital.   The  prognosis  was  unfavorable. 

Case  18.    A  native  of  Hungary.    Age  35  years.    A  single  man. 

This  patient  landed  at  New  York  in  April,  1913.  He  went  to  a  western  state,  and 
the  day  of  his  return  to  New  York  City,  in  May,  1913,  he  was  admitted  to  the 
psychopathic  ward  for  observation.  He  was  transferred  as  insane  to  a  State  hospital. 
His  diagnosis  was  general  paresis.  He  was  finally  deported  by  the  United  States 
Immigration  Service. 

Case  19.    A  native  of  Italy.    Age  33  years.    A  married  woman. 

This  patient  on  the  way  over  to  the  United  States  had  given  birth  to  a  child. 
She  had  been  allowed  to  enter  a  hospital  in  the  City  by  the  immigration  authorities. 
She  was  then  brought  by  the  ambulance  of  that  hospital  to  Bellevue  Hospital.  Her 
husband,  who  accompanied_  her  on  the  voyage,  was  detained  at  Ellis  Island  until  she 
was  able  to  travel.     She  did  not  pay  for  the  medical  treatment  and  maintenance  re- 


212  HOSPITAL   COMMITTEE 

ceived  at  the  Hospital.     She  was  discharged  in  the  custody  of  the  United  States  Im- 
migration Service  and  was  permitted  to  land  the  following  day. 

Case  20.     A  native  of  Austria.    Age  43  years.    A  married  man. 

This  patient  landed  at  New  York  June  11,  191 1.  He  was  admitted  to  the  Hos- 
pital suffering  from  chronic  myocarditis,  with  a  history  of  condition  existing  prior 
to  landing.  The  general  condition  of  his  health  was  too  poor  for  him  to  be  able  to 
do  any  work.  He  had  no  savings  at  the  time  of  admission  to  the  Hospital,  as  he 
had  been  out  of  work  since  January,  1913.  He  had  been  a  patient  at  Bellevue  previ- 
ously. His  wife  and  4  children,  living  in  Austria,  were  dependent  upon  him  for  sup- 
port.   He  had  no  relatives  in  this  country.    The  prognosis  was  unfavorable. 

Case  21.     A  native  of  Austria.    Age  19  years.    A  single  woman. 

This  patient  landed  at  New  York  April  29,  1913.  On  May  26,  1913,  she  was  taken 
to  the  Hospital  for  psychopathic  observation.  She  had  an  insane  sister.  Her  history 
showed  underlying  prior  causes.  She  was  deported  by  the  United  States  Immigration 
Service. 

Case  22.    A  native  of  Russia.    Age  25  years.    A  single  woman. 

This  patient  landed  at  New  Yoi-k  August  27,  1912.  She  was  admitted  to  the 
psychopathic  ward  for  observation  and  transferred  as  insane  to  a  State  hospital.  Her 
history  indicated  underlying  prior  causes.  She  vv-as  deported  by  the  United  States 
Immigration  Service. 

Case  23.    A  native  of  Germany.    Age  25  years.    A  single  woman. 

This  patient  landed  at  New  York  in  December,  1910.  She  was  admitted  for 
psychopathic  observation  and  transferred  as  insane  to  a  State  hospital.  Her  history 
showed  that  she  had  been  in  an  asylum  in  Europe.  She  was  deported  by  the  United 
States  Immigration  Service. 

Case  24.     A  native  of  Switzerland.    Age  22  years.    A  single  man. 

This  patient  landed  at  New  York  October  14,  1910.  He  was  admitted  to  the 
Hospital  to  be  treated  for  chronic  alcoholism.  He  was  transferred  to  the  psychopathic 
ward  for  observation  and  later  was  sent  as  insane  to  a  State  hospital.  He  had  no 
relatives  in  this  country.    The  prognosis  was  unfavorable. 

Case  25.    A  native  of  Italy.    Age  24  years.    A  single  man. 

This  patient  landed  at  New  Y'ork  for  the  second  time  October  25,  1912.  His 
medical  history  showed  that  he  had  been  under  psychopathic  observation  at  Bellevue 
6  years  before  during  a  previous  stay  in  this  country,  at  which  time  he  was  trans- 
ferred as  insane  to  a  State  hospital.  He  was  again  transferred  as  insane  to  a  State 
hospital.     The  prognosis  was  unfavorable. 

Case  26.     A  native  of  Greece.     Age  35  years.    A  married  woman. 

This  patient  and  her  husband  landed  at  New  York  in  April,  1913.  She  was  first 
admitted  to  a  private  hospital  and  from  there  transferred  to  Bellevue  Hospital.  She 
was  suffering  from  hysteria,  due  to  pregnancy,  of  3  months  e.xistence.  Her  husband 
was  unemployed  at  the  time  and  could  not  pay  for  the  medical  treatment  and  main- 
tenance at  the  Hospital.  She  was  readmitted  to  Bellevue  within  3  days  after  dis- 
charge. 

Case  27.     A  native  of  Ireland.     Age  25  years.     A  single  man. 

This  patient  landed  at  New  York  May  13,  191 1.  The  medical  record  showed  that 
he  had  been  an  alcoholic  for  4  or  5  years.  The  diagnosis  was  chronic  alcoholism 
and  acute  gastritis.  He  had  no  relatives  in  this  country  and  had  no  savings  at  the 
time  of  admission  to  the  Hospital.    The  prognosis  was  unfavorable. 

Case  28.     A  native  of  Austria.    Age  18  years.    A  single  woman. 

This  patient  landed  at  New  York  April  22,  1913.  Her  medical  history  showed 
that  sh-e  had  multiple  septic  arthritis,  from  which  she  had  been  suffering  prior  to 
landing.  She  was  alone  in  this  country  and  had  no  savings.  She  was  discharged  in 
the  custody  of  an  immigrants'  society.    The  prognosis  was  unfavorable. 

Case  29.     A  native  of  Russia.    Age  20  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1913.  She  was  admitted  to  the  Hospital  for 
psychopathic  observation.     Her  medical  history  showed  her  condition   existed  prior 


ALIENS  AND   NON-RESIDENTS  213 

to  landing,  and  that  there  was  insanity  in  the  family.     She  was  transferred  as  insane 
to  a  State  hospital.     The  prognosis  was   unfavorable. 

Case  30.    A  native  of  Germany.    Age  unknown.    A  single  man. 

This  patient  landed  at  New  York  in  1912.  He  was  arrested  for  assault  and  re- 
ferred to  the  psychopathic  ward  for  observation.  The  diagnosis  was  insanity  with 
criminal  tendencies,  with  a  history  of  condition  existing  prior  to  landing.  The  prog- 
nosis was  unfavorable. 

Case  31.    A  native  of  Finland.    Age  26  years.    A  single  man. 

This  patient  was  a  discharged  seaman.  He  came  to  New  York  City  last  in  April, 
1913,  and  assumed  occupation  in  the  employ  of  an  electrical  company.  He  had  ma- 
laria, contracted  7  months  prior  to  his  admission.  He  had  no  relatives  in  the  United 
States  and  his  mother  in  Finland  was  dependent  upon  him.  He  had  no  savings  at 
the  time  of  admission  to  the  Hospital.  The  prognosis  was  unfavorable,  as  the  pa- 
tient would  probably  need  further  hospital  treatment. 

Case  32.     A  native  of  Spain.    Age  22  years.    A  single  man. 

This  patient  landed  at  New  York  December  16,  191 1.  He  was  admitted  to  the 
Hospital  to  undergo  an  operation  for  hernia,  which  he  had  had  since  childhood.  He 
had  no  relatives  in  this  country  and  no  savings  at  the  time  of  admission  to  the  Hos- 
pital.   The  prognosis  was  favorable. 

Case  33.    A  native  of  Hungary.    Age  34  years.     A  married  man. 

This  patient  landed  at  New  York  in  1912.  He  was  brought  to  the  Hospital  from 
outside  the  City  for  psychopathic  observation.  He  was  transferred  as  insane  to  a 
State  hospital.     His  history  showed  that  his  condition  originated  prior  to  landing. 

Case  34.     A  native  of  Germany.    Age  25  years.    A  married  woman. 

This  patient  landed  at  New  York  in  1911.  The  medical  history  showed  that  her 
mother  had  been  peculiar  and  that  the  patient  had  had  previous  attacks  of  insanity. 
She  was  transferred  as  insane  to  a  State  hospital. 

Case  35.    A  native  of  Italy.    Age  42  years.    A  single  man. 

This  patient  landed  at  New  York  May  31,  1913.  His  diagnosis  was  rheumatism, 
from  which,  his  medical  history  showed,  he  had  been  suffering  on  board  ship. 
Also,  he  had  had  gonorrhea  previously.  At  the  time  of  admission  to  the  Hospital  he 
had  no  savings.  His  cousin,  the  only  relative  he  had  in  this  City,  was  unable  to  help 
him  financially.  The  prognosis  indicated  that  this  patient  would  in  all  probability 
require  subsequent  treatment. 

Case  36.    A  native  of  Austria.    Age  29  years.    A  married  man. 

This  patient  landed  at  New  York  March  12,  191 1.  He  had  been  suffering  from 
a  chronic  urethral  fistula,  for  which  he  had  been  operated  upon  in  Europe.  He  was 
a  waiter,  unemployed  for  10  weeks  prior  to  admission  to  the  Hospital.  He  had  no 
savings  with  which  to  pay  for  medical  treatment  and  maintenance.  The  prognosis 
was  unfavorable. 

Case  37.    A  native  of  Germany.    Age  27  years.    A  single  woman. 

This  patient  landed  at  New  York  in  December,  1912.  She  was  admitted  to  the 
psychopathic  ward  for  observation.  Her  medical  history  showed  that  her  mother  was 
peculiar  and  that  the  patient  had  had  mental  peculiarities  of  many  years  standing. 
The  prognosis  was  unfavorable. 

Case  38.    A  native  of  Russia.    Age  35  years.     A  married  woman. 

This  patient  landed  at  New  York  in  April,  1913.  She  was  admitted  to  the  Hos- 
pital for  parturition.  She  was  pregnant  prior  to  landing.  Her  husband  had  been  out 
of  work  for  some  time.  There  were  3  children  in  the  family,  all  dependent  upon  the 
father  for  support,  and  they  had  no  money  at  the  time  of  his  admission  to  the  Hospital. 

Case  39.    A  native  of  Russia.    Age  40  years.    A  married  man. 

This  patient  landed  at  New  York  March  18,  1912.  His  medical  history  showed 
that  he  had  been  suffering  from  rheumatism  for  6  years.  The  diagnosis  was  chronic 
rheumatism  and  syphilis  of  the  brain.  He  was  transferred  to  a  chronic  hospital.  He 
had  been  out  of  work  for  6  months  prior  to  admission.     He  had  made  only  $3.00  a 


214  HOSPITAL   COMMITTEE 

week  when  employed  and  had  no  savings  at  the  time  of  admission  to  the  Hospital. 
He  wished  to  be  sent  back  to  Russia.    The  prognosis  was  unfavorable. 

Case  40.    A  native  of  Germany.    Age  28  years.    A  single  man. 

This  patient  was  a  seaman.  He  was  taken  to  the  Hospital  to  be  treated  for  an 
injury  which  he  sustained  on  board  of  ship  prior  to  landing.  The  diagnosis  was  for 
suppurative  condition  of  the  right  shoulder.  He  had  no  savings  at  the  time  of  admis- 
sion to  the  Hospital  and  could  not  pay  for  the  treatment  and  maintenance  he  received 
there.  The  steamship  company  did  not  reimburse  the  Hospital.  The  prognosis  for 
ultimate  recovery  was  favorable.  The  patient  was  referred  to  the  Department  of 
Public  Charities  for  further  care. 

Case  41.    A  native  of  Austria.    Age  53  years.    A  single  woman. 

This  patient  was  admitted  to  the  United  States  in  1910.  She  was  in  the  Hospital 
for  psychopathic  observation  and  was  transferred  as  insane  to  a  State  hospital.  Her 
history  showed  that  her  condition  originated  before  landing.  The  prognosis  was  un- 
favorable. 

Case  42.    A  native  of  Italy.    Age  28  years.    A  single  man. 

This  patient  landed  at  New  York  in  May,  1912.  His  medical  history  showed  that 
he  had  had  discharges  from  his  ears  for  6  years,  and  also  had  had  frequent  attacks 
of  tonsilitis.  The  diagnosis  was  acute  tonsilitis  and  chronic  otitis  media  of  both  ears. 
He  had  no  relatives  in  this  country.  He  earned  small  wages  when  employed  and  had 
no  savings  at  the  time  of  admission  to  the  Hospital.    The  prognosis  was  unfavorable. 

Case  43.     A  native  of  Austria.    Age  25  years.    A  married  man. 

This  patient  landed  at  New  York  January  5,  1912.  He  was  admitted  to  the  Hos- 
pital suffering  from  rheumatism  and  organic  heart  disease,  with  history  of  condition 
existing  prior  to  landing.  He  made  only  $10.00  per  week,  and  had  a  wife  and  child 
dependent  upon  him  for  support.  He  had  no  savings  and  no  relatives  able  to  give 
him  any  aid.    The  prognosis  was  unfavorable. 

Case  44.    A  native  of  Russia.    Age  32  years.     A  single  man. 

This  patient  landed  at  New  York  November  13,  1912.  He  was  admitted  to  the 
Hospital  for  psychopathic  observation.  His  medical  history  showed  that  his  condi- 
tion originated  prior  to  landing  with  continuous  symptoms  since  landing.  His  sister 
was  an  inmate  of  a  State  hospital  for  the  insane.  The  patient  was  transferred  as 
insane  to  a  State  hospital. 

Case  45.     A  native  of  Russia.    Age  32  years.    A  married  woman. 

This  patient  landed  at  New  York  July  24,  1912.  She  had  had  an  operation  as  a 
free  patient  in  a  private  hospital  in  this  City.  The  diagnosis  was  a  malignant  ab- 
dominal tumor,  with  history  of  development  of  such  prior  to  landing.  Her  husband 
earned  $10.00  per  week  and  could  not  pay  for  her  maintenance  at  the  Hospital.  There 
were  2  dependent  children  in  the  family.    The  prognosis  was  unfavorable. 

Case  46.    A  native  of  Italy.    Age  39  years.    A  married  woman. 

This  patient  landed  at  New  York  November  24,  1912.  In  January,  1913,  she  was 
admitted  to  a  private  hospital,  where  she  had  an  operation  for  carcinoma  of  cervix. 
In  June,  1913,  she  was  admitted  to  Bellevue  Hospital.  The  diagriosis  was  inoperable 
cancer  of  uterus  and  of  skin.  Her  history  showed  that  this  condition  originated  prior 
to  landing.  Her  husband  was  an  unskilled  laborer  without  regular  income.  The 
prognosis  was  unfavorable. 

Case  47.    A  native  of  Turkey.     Age  11  years.     A  boy. 

This  patient  landed  at  New  York  in  September,  1912.  His  medical  history  indi- 
cated backwardness  of  mental  development,  edema  of  face,  and  chronic  valvular  heart 
disease  since  early  childhood.  The  father  of  this  patient,  a  laborer,  earned  from 
$8.00  to  $10.00  per  week.  There  were  S  dependent  children  in  the  family.  The  prog- 
nosis was  unfavorable. 

Case  48.    A  native  of  Greece.    Age  37  years.    A  married  man. 

This  patient  landed  at  New  York  in  1910.  He  was  admitted  for  psychopathic  ob- 
servation. The  diagnosis  was  general  paresis.  The  medical  history  showed  that  his 
condition  originated  prior  to  landing.  This  patient  was  transferred  as  insane  to  a 
State  hospital.     The  prognosis  was  unfavorable. 


ALIENS  AND   NON-RESIDENTS  21 5 

Case  49.    A  native  of  Ireland.    Age  35  years.    A  single  woman. 

This  patient  landed  at  New  York  in  April,  1912,  but  did  not  settle  in  this  City. 
On  June  10,  1913,  she  came  from  New  Haven,  Conn.,  and  the  next  day  was  admit- 
ted to  the  Hospital.  Her  medical  history  showed  constitutional  psychopathic  tenden- 
cies existing  prior  to  landing.  She  was  also  an  alcoholic.  This  woman  had  no  sav- 
ings at  the  time  of  admission  to  the  Hospital.  She  had  no  relatives  in  this  country, 
no  permanent  residence  or  settlement,  and  no  regular  income.  The  prognosis  was 
unfavorable. 

Case  50.    A  native  of  Ireland.    Age  25  years.    A  single  man. 

This  patient  landed  at  New  York  in  July,  1912.  He  was  a  chronic  alcoholic  and 
admitted  that  he  had  been  addicted  to  the  use  of  alcohol  since  16  years  of  age.  He 
had  no  relatives  in  this  country,  no  savings,  and  his  work  was  irregular.  The  prog- 
nosis was  unfavorable. 

Case  51.    A  native  of  Italy.    Age  36  years.    A  single  man. 

This  patient  landed  at  New  York  in  December,  1912.  The  diagnosis  of  his  illness 
was  bleeding  hemorrhoids  and  severe  secondary  anemia,  with  cardiac  involvement. 
His  history  showed  that  his  condition  existed  prior  to  landing,  with  acute  syrnptoms 
of  6  months  existence.  He  was  discharged  in  an  unimproved  condition  at  his  own 
risk.  He  had  no  savings  at  the  time  of  admission  to  the  Hospital  and  no  relatives 
able  to  assist  him.    The  prognosis  was  unfavorable. 

Case  52.    A  native  of  Greece.    Age  35  years.    A  married  woman. 

This  patient  and  her  husband  landed  at  New  York  in  April,  1913.  She  was  first 
admitted  to  a  private  hospital  and  from  there  transferred  to  Bellevue  Hospital.  She 
was  suffering  from  hysteria,  due  to  pregnancy,  of  3  months  existence.  Her  husband 
was  unemployed  at  the  time  and  could  not  pay  for  the  medical  treatment  and  main- 
tenance at  the  Hospital. 

Case  53.    A  native  of  Ireland.    Age  27  years.    A  single  man. 

This  patient  landed  at  New  York  June  29,  1912.  His  medical  history  showed  that 
he  had  had  asthma  since  childhood.  The  diagnosis  was  asthma  and  suppurative  area 
on  chest,  secondary  to  old  wound  by  stabbing.  This  patient  had  earned  very  little 
and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  His  relatives  were  poor 
and  unable  to  give  him  any  assistance.     The  prognosis  was  unfavorable. 

Case  54,     A  native  of  Russia.    Age  40  years.    A  married  man. 

This  patient  landed  at  New  York  in  1912.  He  was  admitted  to  the  Hospital  for 
psychopathic  observation  and  was  transferred  as  insane  to  a  State  hospital.  His  his- 
tory showed  that  this  condition  had  originated  prior  to  landing.  The  prognosis  was 
unfavorable. 

Case  55.    A  native  of  Austria.     Age  16  years.     A  boy. 

This  patient  landed  at  New  York  in  January,  1912.  The  diagnosis  was  acute 
rheumatic  fever,  myocarditis,  and  general  arthritis.  His  history  showed  that  this 
condition  originated  prior  to  landing.  He  had  earned  $16.00  a  month  in  a  factory. 
His  father,  a  mill  worker,  could  not  pay  for  his  maintenance  and  treatment  at  the 
Hospital.     The  prognosis  was  unfavorable. 

Case  56.  '  A  native  of  Cuba.     Age  9  years.     A  boy. 

This  patient  was  admitted  to  the  United  States  in  March,  1913.  In  April,  1913, 
he  came  from  San  Francisco  to  this  City.  He  had  abscess  of  the  brain.  His  history 
showed  that  this  condition  originated  prior  to  landing.  His  father,  a  storekeeper, 
had  an  income  of  about  $25.00  per  month.  There  were  5  dependent  children  in  the 
family.     The  prognosis  was  unfavorable. 

Case  57.    A  native  of  Russia.    Age  34  years.    A  married  man. 

Tbis  patient  landed  at  New  York  July  i,  1912.  He  was  admitted  to  the  Hos- 
pital for  psychopathic  observation.  His  medical  history  recorded  mental  peculiarities 
in  childhood  and  insanity  in  Russia.  He  had  been  non-supporting  since  entry  into 
this  country.  He  was  transferred  as  insane  to  a  State  hospital  and  referred  to  the 
United  States  Immigration  Service  for  deportation.    The  prognosis  was  unfavorable. 


2l6  HOSPITAL   COMMITTEE 

Case  58.     A  native  of  Italy.     Age  30  years.     A  single  man. 

This  patient  landed  at  New  York  in  April,  191 1.  The  diagnosis  was  urethral 
stricture  and  chronic  gonorrhea.  His  medical  history  recorded  an  attack  of  gonor- 
rhea in  Europe  prior  to  landing,  which  was  followed  by  a  gradual  obstruction  in  ure- 
thral flow.  This  man  had  no  relatives  here  and  had  no  savings.  The  prognosis  was 
unfavorable. 

Case  59.    A  native  of  Russia.    Age  28  years.    A  married  man. 

This  patient  landed  at  New  York  April  14,  1913.  The  diagnosis  was  pulmonary 
tuberculosis  and  general  arthritis.  This  was  his  second  admission  to  Bellevue  Hos- 
-pital.  His  history  showed  that  his  condition  had  originated  prior  to  landing.  He  had 
been  out  of  work  since  May,  1913.  His  brother,  a  laborer,  could  not  help  him  in  any 
way.    The  prognosis  was  unfavorable. 

Case  60.     A  native  of  Russia.    Age  29  years.     A  single  man. 

This  patient  landed  at  New  York  in  January,  1913.  He  was  admitted  to  the 
psychopathic  ward  for  observation.  The  medical  records  indicated  that  he  had  been 
constitutionally  defective.  He  had  been  dependent  on  charity  ever  since  landing  in 
this  country.    The  prognosis  was  unfavorable. 

Case  61.     A  native  of  Russia.    Age  21  years.    A  single  woman. 

This  patient  landed  at  New  York  in  January,  191 1.  Her  condition  was  diag- 
nosed as  hysteria.  Her  history  showed  that  she  was  mentally  unstable  prior  to  land- 
ing. This  woman  had  been  out  of  work  for  2  weeks  before  admission  to  the  Hos- 
pital. She  had  no  savings  and  her  sister,  the  only  relative  she  had  in  this  country, 
was  unable  to  render  her  any  material  assistance.     The  prognosis  was  unfavorable. 

Case  62.    A  native  of  Italy.    Age  19  years.    A  single  man. 

This  patient  landed  at  New  York  in  December,  1912.  He  was  admitted  to  the 
Hospital  for  psychopathic  observation  and  transferred  to  a  State  hospital  as  insane. 
His  history  showed  that  his  condition  originated  prior  to  landing.  He  was  referred 
to  the  United  States  Immigration  Service  for  deportation. 

Case  63.    A  native  of  Sweden.    Age  40  years.    A  single  woman. 

This  patient  landed  at  New  York  October  i,  191 1.  The  diagnosis  was  criminal 
abortion,  perforated  uterus,  secondary  pelvic  sepsis.  Her  medical  history  showed 
that  she  had  had  another  criminal  abortion  3  years  prior  to  admission  to  the  Hos- 
pital. She  had  no  relatives  in  this  State.  She  had  no  savings  at  the  time  of  admis- 
sion to  the  Hospital.    The  prognosis  was  unfavorable. 

CLASS  I-sa.    Aliens  Deportable  under  the  State  Charities  Law. — From  causes  ex- 
isting prior  to  landing. 

Case  i.     A  native  of  Russia.    Age  40  years.    A  married  man. 

This  patient  landed  at  New  York  in  October,  1908.  The  diagnosis  was  chronic 
myocarditis  and  asthma,  with  history  of  condition  existing  prior  to  landing.  He 
earned  only  $6.00  a  week  and  had  a  wife  and  5  small  children  in  Europe.  A 
daughter  was  working  out  at  service  in  this  country.    The  prognosis  was  unfavorable. 

Case  2.    A  native  of  Russia.    Age  43  years.    A  married  man. 

This  patient  landed  at  New  York  in  1908.  The  diagnosis  was  syphilis,  with  a  his- 
tory of  condition  existing  prior  to  landing.  He  also  had  tabes  dorsalis,  chronic 
pleurisy,  and  chronic  splenitis.  He  had  earned  $18.00  a  week  when  employed.  His 
money  was  exhausted.  His  wife,  and  s  children  under  20  years  of  age,  were  in  Rus- 
sia.   The  prognosis  was  unfavorable. 

Case  3.    A  native  of  Germany.    Age  62  years.    A  married  man. 

This  patient  landed  at  New  York  in  1891.  The  diagnosis  was  chronic  alcoholism, 
with  an  alcoholic  history  for  years  prior  to  landing.  His  relatives  were  in  Europe. 
The  prognosis  was  unfavorable. 

Case  4.     A  native  of  Italy.    Age  26  years.    A  single  man. 

This  patient  landed  at  New  York  in  June,  1909.  The  diagnosis  was  tuberculosis 
of  elbow  joint,  chronic  cardiac  disease,  and  pulmonary  tuberculosis.  Four  years  be- 
fore, and  prior  to  landing,  he  sustained  an  injury  to  his  elbow.     He  had  been  working 


ALIENS  AND   NON-RESIDENTS  217 

as  a  hotel  helper  and  earned  very  little.  He  had  been  out  of  work  for  some  time 
before  admission  to  the  Hospital  and  had  no  savings.  A  sister,  a  laundress,  earned 
$5.00  a  week  and  could  give  him  little  assistance.    The  prognosis  was  unfavorable. 

Case  5.     A  native  of  Ireland.    Age  29  years.    A  married  man. 

This  patient  landed  at  New  York  in  September,  igoS.  The  diagnosis  was  chronic 
alcoholism.  The  history  of  this  patient  showed  that  he  had  been  a  chronic  alcoholic 
for  6  years.  When  employed  he  earned  $16.00  a  week.  He  had  a  wife  dependent  upon 
him.  He  had  no  savings  and  did  not  pay  for  the  medical  treatment  and  maintenance 
received  at  the  Hospital.    The  prognosis  was  unfavorable. 

Case  6.    A  native  of  Ireland.    Age  43  years.    A  single  man. 

This  patient  landed  at  New  York  July  13,  1897.  The  diagnosis  was  chronic  alco- 
holism, with  an  alcoholic  history  prior  to  landing.  He  had  been  a  public  charge  many 
years  before  because  of  alcoholism.  This  man  had  no  savings  at  the  time  of  admis- 
sion to  the  Hospital  and  could  not  pay  for  the  medical  treatment  and  maintenance 
received  therein.     The  prognosis  was   unfavorable. 

Case  7.     A  native  of  Ireland.    Age  35  years.    A  single  man. 

This  patient  landed  at  New  York  in  July,  igoo.  The  diagnosis  was  chronic  alco- 
holism, with  an  alcoholic  history  prior  to  landing.  He  had  no  savings  and  no  rela- 
tives in  this  country.     The  prognosis  was  unfavorable. 

Case  8.     A  native  of  Ireland.    Age  25  years. 

This  patient  landed  at  Boston,  Mass.,  in  April,  1907.  In  March,  1913,  he  came 
from  Boston  to  this  City.  He  was  admitted  to  the  Hospital  to  be  treated  for  acute 
gastritis  following  alcoholic  poisoning.  This  man  was  a  chronic  alcoholic,  with  an 
alcoholic  history  prior  to  landing.  He  had  no  relatives  in  this  City  and  had  no  sav- 
ings at  the  time  of  admission  to  the  Hospital.    The  prognosis  was  unfavorable. 

Case  9.     A  native  of  Germany.    Age  29  years.    A  single  man. 

This  patient  landed  at  New  York  September  26,  1900.  He  was  admitted  to  the 
Hospital  to  be  treated  for  acute  gastritis  following  alcoholic  poisoning.  He  was  a 
chronic  alcoholic,  with  an  alcoholic  history  prior  to  landing.  He  had  no  savings  at 
the  time  of  admission  to  the  Hospital  and  no  relatives  in  this  country.  The  prognosis 
was  unfavorable. 

Case  10.     A  native  of  Ireland.    Age  24  years.    A  single  man. 

This  patient  landed  at  New  Y'ork  in  April,  1909.  He  was  admitted  to  the  Hos- 
pital to  be  treated  for  a_ fracture  of  fibula,  which  he  received  while  in  an  intoxicated 
condition.  The  diagnosis  was  delirium  tremens  and  fracture  of  leg.  His  medical 
history  showed  that  he  had  been  a  chronic  alcoholic,  with  an  alcoholic  history  prior 
to  landing,  This  man  was  an  unskilled  laborer.  His  work  was  irregular  and  he  had 
no  savings.    The  prognosis  was  unfavorable. 

Case  ii.     A  native  of  Norway.    Age  49  years.    A  single  man. 

This  patient  landed  at  New  York  in  1901.  The  diagnosis  was  chronic  arthritis 
and  chronic  valvular  cardiac  disease.  His  medical  history  showed  a  record  of  re- 
peated attacks  of  rheumatism  since  the  age  of  16,  and  valvular  cardiac  disease  prior 
to  landing.  He  had  been  out  of  work  for  some  time  and  had  no  savings  at  the  time 
of  admission  to  the  Hospital,  and  no  relatives  in  this  part  of  the  country.  The 
prognosis  was  unfavorable. 

Case  12.     A  native  of  Ireland.    Age  35  years.    A  single  man. 

This  patient  landed  at  New  York  in  October,  1904.  His  diagnosis  was  chronic 
alcoholism,  existing  prior  to  landing.  He  was  an  unskilled  laborer.  He  had  no  sav- 
ings and  no  regular  income.    The  prognosis  was  unfavorable. 

Case  13.     A  native  of  Germany.    Age  28  years.    A  single  man. 

This  patient  landed  at  New  York  in  1904.  The  diagnosis  was  alcoholic  poisoning 
and  toxic  psychosis.  His  medical  history  showed  chronic  alcoholism  prior  to  land- 
ing. This  man  had  no  savings  at  the  time  of  admission  to  the  Hospital.  The  prog- 
nosis was  unfavorable. 


2l8  HOSPITAL   COMMITTEE 

Case  14.    A  native  of  Roumania.    Age  22  years.    A  single  woman. 

This  patient  landed  at  New  York  August  S,  I907-  She  had  an  exophthalmic 
goiter  of  6  years  existence,  originating  prior  to  landing.  Her  condition  was  such 
as  would  probably  make  her  an  invalid  for  life.  She  lived  with  her  parents.  Her 
father  had  no  occupation,  and  the  family  subsisted  upon  the  earnings  of  2  of  the 
older  children,  who  earned  $8.00  and  $12.00,  respectively.  They  were  unable  to  pay 
for  the  medical  treatment  and  maintenance  the  patient  received  at  the  Hospital.  The 
prognosis  was  unfavorable. 

Case  15.    A  native  of  Italy.    Age  35  years.    A  married  man. 

This  patient  landed  at  New  York  in  1906.  He  was  admitted  to  the  Hospital  to 
be  treated  for  a  fistula  of  the  urethra,  with  a  history  of  condition  existing  prior  to 
landing.  He  also  had  syphilis.  He  was  discharged  in  an  unimproved  condition,  un- 
doubtedly in  need  of  further  medical  treatment.  He  had  no  savings  and  no  relatives 
in  this  country.  His  wife  lived  in  Italy  and  depended  upon  him  for  support.  The 
prognosis  was  unfavorable. 

Case  16.    A  native  of  Austria.    Age  55  years.    A  married  man. 

This  patient  came  to  New  York  in  March,  1909,  as  a  second-class  passenger.  The 
diagnosis  of  his  condition  was  calculus  of  right  kidney,  chronic  sciatic  rheumatism, 
asthma,  and  chronic  valvular  cardiac  disease,  with  history  of  conditions  existing 
prior  to  landing.  He  was  a  peddler  and  his  income  was  uncertain.  Because  of  illness 
he  had  not  done  anything  for  2  months  prior  to  admission  to  the  Hospital.  His 
wife,  so  years  old,  and  i  child  were  dependent  upon  him  for  support.  He  had  2 
daughters  working  as  domestics,  whose  whereabouts  were  unknown.  The  prognosis 
was  unfavorable. 

Case  17.    A  native  of  Ireland.    Age  46  years.    A  single  man. 

This  patient  landed  at  New  York  April  23,  1909.  The  diagnosis  was  chronic 
alcoholism,  which  existed  prior  to  landing.  This  man  had  no  savings  at  the  time 
of  admission  to  the  Hospital.     The  prognosis  was  unfavorable. 

Case  18.    A  native  of  Italy.    Age  40  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1907.  The  diagnosis  was  subacute  sep- 
ticaemia and  chronic  cardiac  disease.  Her  medical  history  showed  that  she  had  been 
a  chronic  cardiac  prior  to  landing.  Three  years  before  entering  the  Hospital  the  pa- 
tient had  a  miscarriage,  though  unmarried.  This  woman  was  alone  in  the  United 
States,  earned  only  $6.00  per  week  when  employed,  and  had  no  savings  at  the  time  of 
admission  to  the  Hospital.    The  prognosis  for  recovery  was  unfavorable. 

Case  19.     A  native  of  Germany.    Age  36  years.    A  single  man. 

This  patient  landed  at  New  York  in  August.  1903.  He  was  a  chronic  alcoholic, 
addicted  to  the  use  of  alcohol  since  the  age  of  18,  and  a  "repeater"  at  Bellevue.  He 
had  been  out  of  work  for  3  weeks  and  had  no  savings  at  the  time  of  admission  to 
the  Hospital.    The  prognosis  was  unfavorable. 

Case  20.    A  native  of  Ireland.    Age  27  years.    A  married  man. 

This  patient  landed  at  New  York  August  29,  1907.  He  had  been  admitted  to  the 
Hospital  to  be  operated  upon  for  an  abscess  about  the  rectum.  After  the  operation 
he  developed  delirium  tremens.  His  medical  history  showed  that  he  had  been  a 
drinking  man  for  many  years,  and  prior  to  landing.  He  had  earned  $12.00  a  week 
as  a  blacksmith.  His  wife  and  a  s-year-old  child  were  dependent  upon  him  for  sup- 
port. At  the  time  of  entering  the  Hospital  he  had  no  savings  and  could  not  pay  for 
the  medical  treatment  and  maintenance  therein.    The  prognosis  was  unfavorable. 

Case  21.    A  native  of  Ireland.    Age  41  years.    A  single  man. 

This  patient  landed  at  New  York  in  January,  1900.  The  diagnosis  was  alcoholic 
poisoning.  His  medical  history  showed  that  he  had  chronic  alcoholism  and  constitu- 
tional psychopathic  tendencies  existing  prior  to  landing.  This  was  at  least  his  fourth 
admission  to  Bellevue  Hospital.  He  was  employed  irregularly  as  a  hospital  helper. 
He  had  been  out  of  work  for  i  month  before  entering  the  Hospital.  He  had  no  sav- 
ings and  no  relatives  willing  to  pay  for  his  maintenance  at  the  Hospital.  The  prog- 
nosis was  unfavorable. 


ALIENS  AND   NON-RESIDENTS  219 

Case  22.    A  native  of  Austria.    Age  28  years.    A  single  man. 

This  patient  landed  in  the  United  States  in  1904,  and  came  to  this  City  from 
Pennsylvania  a  day  before  admission  to  the  Hospital.  He  was  a  chronic  alcoholic, 
and  his  medical  history  indicated  that  he  had  been  addicted  to  the  use  of  alcohol 
prior  to  landing.  He  was  a  "repeater"  at  Bellevue.  He  had  been  out  of  work  for 
some  time  and  had  no  money  at  the  time  of  admission  to  the  Hospital.  He  had  no 
relatives  in  this  country.    The  prognosis  was  unfavorable. 

Case  23.    A  native  of  Italy.    Age  38  years.    A  married  woman. 

This  patient  landed  at  New  York  in  August,  1909.  Her  medical  history  showed 
that  she  had  been  an  invalid  prior  to  landing  from  uterine  trouble,  resulting  in  carci- 
noma of  the  cervix.  This  woman  was  discharged  in  an  unimproved  condition.  Her 
husband  was  unable  to  pay  for  the  medical  treatment  and  maintenance  she  received 
at  the  Hospital.  The  patient  will  undoubtedly  need  further  care.  The  prognosis  was 
unfavorable. 

Case  24.    A  native  of  Hungary.*  Age  17  years.    A  single  woman. 

This  patient  landed  at  New  York  in  December,  igog.  The  diagnosis  was  hysteria 
and  constitutional  mental  inferiority.  Her  condition  must  have  originated  prior  to 
landing.  This  was  at  least  the  third  instance  of  the  patient's  dependence  upon  the 
City.    The  prognosis  was  unfavorable. 

Case  25.    A  native  of  Ireland.    Age  47  years.    A  single  man. 

This  patient  landed  at  New  York  in  January,  1904.  He  had  been  suffering  from 
chronic  myocarditis.  His  condition  originated  prior  to  landing.  He  had  been  out  of 
work  a  whole  year.  He  had  no  savings  and  no  relatives  in  this  country.  The  prog- 
nosis was  unfavorable. 

Case  26.    A  native  of  England.    Age  39  years.    A  single  man. 

This  patient  landed  at  New  York  in  March,  1907,  as  a  second-class  passenger. 
The  diagnosis  was  of  recurrent  arthritis  of  hips.  His  medical  history  recorded  rheum- 
atism 28  years  ago  and  6  subsequent  outbreaks  of  syphilis.  This  was  at  least  his  sec- 
ond admission  to  Bellevue  Hospital.  He  had  been  employed  irregularly,  and  had  no 
savings  at  the  time  of  admission  and  no  relatives  in  this  country.  The  prognosis  was 
unfavorable. 

Case  27.    A  native  of  Ireland.    Age  32  years.    A  single  man. 

This  patient  landed  at  New  York  June  11,  1908.  The  diagnosis  was  chronic  alco- 
holism. His  medical  history  showed  that  he  had  been  addicted  to  the  use  of  alcohol 
since  the  age  of  22.  This  was  at  least  his  second  admission  to  Bellevue.  He  had  no 
definite  occupation.  He  was  employed  irregularly  and  had  no  savings  at  the  time 
of  admission  to  the  Hospital.  His  father  was  living  in  Ireland.  The  prognosis  was 
unfavorable. 

Case  28.     A  native  of  Germany.     Age  40  years.     A  single  man. 

This  patient  landed  at  New  York  in  1899.  The  diagnosis  was  alcoholic  poisoning. 
He  had  been  a  chronic  alcoholic  prior  to  landing.  He  had  previously  been  a  depend- 
ent in  this  City.  He  had  no  savings  and  earned  only  $6.00  per  week  when  employed. 
His  parents  were  in  Germany.     The  prognosis  was  unfavorable. 

Case  29.     A  native  of  Russia.     Age  29  years.    A  married  man. 

This  patient  landed  at  New  York  in  1907.  His  diagnosis  was  chronic  arthritis 
and  deformity  of  hip.  An  aggravated  condition  of  an  old  injury  to  his  hip  necessi- 
tated a  second  operation.  He  had  received  this  injury  in  1903,  4  years  prior  to  land- 
ing. He  had  been  out  of  work  for  2  months  before  entering  the  Hospital.  His 
wife  and  5^  small  children  were  dependent  upon  him  for  support.  His  income  was  un- 
certain and  he  had  no  savings  at  the  time  of  admission  to  the  Hospital.  The  prog- 
nosis was  unfavorable. 

Case  30.    A  native  of  Ireland.    Age  32  years.    A  single  man. 

This  patient  landed  at  New  York  in  May,  1906.  The  diagnosis  was  chronic  alco- 
holism and  chronic  cardiac  disease,  originating  prior  to  landing.  Also,  he  had  had 
syphilis  for  S  years  prior  to  admission  to  the  Hospital.  He  was  an  unskilled  laborer 
and  employed  irregularly.  He  had  been  out  of  work  for  3  weeks  before  entering  the 
Hospital  and  had  no  savings  at  the  time  of  admission  to  the  Hospital,  and  no  rela- 
tives in  this  State.    The  prognosis  was  unfavorable. 


220  HOSPITAL   COMMITTEE 

CLASS  I-sb.    Aliens  Deportable  under  the  State  Charities  Law. — From  causes  whose 
priority  to  landing  is  not  certain. 

Case  i.     A  native  of  Greece.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  in  May,  1912.  The  diagnosis  was  chronic  pul- 
monary tuberculosis.  The  probability  is  that  this  patient  had  this  ailment  prior  to 
landing  in  the  United  States.  His  relatives  all  lived  in  Europe.  He  was  a  bootblack, 
but  had  been  unemployed  for  some  time.    The  prognosis  was  unfavorable. 

Case  2.    A  native  of  Austria.    Age  27  years.    A  married  woman. 

This  patient  landed  at  New  York  in  September,  1910.  The  diagnosis  was  chronic 
pelvic  trouble,  which  probably  originated  prior  to  landing.  Her  condition  was  so  seri- 
ous that  she  died  in  the  Hospital  3  weeks  after  admission.  The  patient  and  r  child 
had  been  dependent  on  her  husband,  who  earned  $13  a  week.  She  had  had  an  opera- 
tion previously. 

Case  3.     A  native  of  Russia.    Age  32  years.    A  single  man. 

This  patient  landed  at  New  York  in  190S.  He  had  chronic  pulmonary  tuber- 
culosis. He  had  been  ill  3  years  and  had  had  previous  hospital  treatment  in  this 
City.  His  trouble  may  have  originated  prior  to  landing.  His  parents  are  still  living 
in  Europe.  The  prognosis  was  unfavorable  for  recovery  and  indicated  chronic  or 
recurrent  dependence. 

Case  4.    A  native  of  Scotland.    Age  39  years.    A  married  man. 

This  patient  landed  at  New  York  in  September,  1908.  He  came  to  New  York 
City  from  New  Jersey  2  weeks  before  admission  to  the  Hospital.  The  diagnosis  was 
chronic  alcoholism,  with  4^2  years  history  of  alcoholism  admitted.  His  family  lived 
in  Scotland.  The  prognosis  was  unfavorable  for  cure  and  indicated  recurrent  or 
chronic  dependence. 

Case  5.     A  native  of  Austria.    Age  unknown.    A  single  man. 

This  patient  landed  at  New  York  in  1903.  The  diagnosis  was  chronic  cardiac 
valvular  disease,  with  complication  of  rheumatic  fever.  The  history  indicated  that 
he  probably  had  these  conditions  prior  to  landing  in  the  United  States.  The  patient 
earned  $15.00  a  week  when  employed,  but  had  been  out  of  work  7  months.  His 
nearest  relative  in  this  country  was  a  cousin.    The  prognosis  was  unfavorable. 

Case  6.     A  native  of  Hungary.    Age  33  years.    A  married  man. 

This  patient  landed  at  New  York  in  June,  1912.  The  diagnosis  was  cancer  of  the 
stomach.  The  medical  history  showed  that  he  had  had  a  gastric  ulcer  prior  to  land- 
ing in  the  United  States.  He  had  earned  $9  a  week  when  employed.  The  prognosis 
was  unfavorable. 

Case  7.     A  native  of  Italy.     Age  20  years.     A  single  man. 

This  patient  landed  in  the  United  States  in  I\'Iay,  1912,  and  came  to  this  City 
from  New  Jersey  in  April,  1913.  The  diagnosis  was  chronic  pulmonary  tuberculosis, 
with  acute  symptoms  of  4  months  existence.  It  could  not  be  determined  whether  his 
illness  was  due  to  causes  existing  prior  to  landing.  He  was  alone  in  this  country. 
He  had  been  out  of  work  2  months  and  had  no  savings  at  the  time  of  admission  to 
the  Hospital.  The  prognosis  was  unfavorable  and  indicated  recurrent  or  chronic  de- 
pendence. 

Case  8.    A  native  of  Italy.    Age  28  years.    A  married  man. 

This  patient  landed  at  New  York  in  October,  1912.  The  diagnosis  was  suppura- 
tive pleurisy,  which  was  probably  due  to  a  tuberculous  condition  prior  to  landing.  He 
was  unemployed  for  2  months  before  entering  the  Hospital  and  had  no  savings.  He 
had  no  relatives  in  this  country.     The  prognosis  for  cure  was  unfavorable. 

Case  9.    A  native  of  Russia.    Age  34  years.    A  married  man. 

This  patient  landed  at  New  York  in  1909.  The  diagnosis  was  cerebro-spinal 
syphilis.  He  had  a  chronic  stomach  trouble  of  14  years  existence.  After  5  days  in 
the  Hospital  he  was  discharged  home  in  an  unimproved  condition.  It  could  not  be 
determined  whether  the  patient  had  been  afflicted  with  the  same  disease  prior  to  land- 
ing.    The  prognosis  was  unfavorable  and  indicated  recurrent  or  chronic  dependence. 


ALIENS   AND   NON-RESIDENTS  221 

Case  io.     A  native  of  Roumania.    Age  38  years.    A  single  man. 

This  patient  landed  at  New  York  in  1907.  The  diagnosis  was  cirrhosis  of  the 
liver  and  cardiac  trouble.  It  was  uncertain  whether  his  condition  originated  prior  tn 
landing.  The  patient's  general  physical  condition  was  poor.  He  was  transferred  to 
a  chronic  hospital.  He  had  been  unemployed  6  months  and  had  no  savings.  The 
prognosis  was  unfavorable.     The  patient  seemed  sure  to  need  subsequent  treatment. 

Case  ii.    A  native  of  Ireland.    Age  35  years.    A  single  man. 

This  patient  landed  at  New  York  June  20,  1905.  The  diagnosis  was  chronic 
cardiac  valvular  disease  and  acute  rheumatic  fever.  It  could  not  be  determined 
whether  his  condition  originated  prior  to  landing.  He  had  been  out  of  work  for  over 
a  month.  He  had  earned  only  $25  a  month  when  employed  and  had  no  savings.  The 
prognosis  for  cure  was  unfavorable.  The  patient  seemed  likely  to  have  recurrent 
attacks. 

Case  12.     A  native  of  Spain.    Age  27  years.    A  single  man. 

This  patient  landed  at  New  York  July  17,  1912.  The  diagnosis  was  secondary 
syphilis.  His  medical  history  had  a  record  of  gonorrhea  5  years  before.  It  was  not 
determined  whether  the  patient  had  contracted  syphilis  prior  to  landing.  He  had  no 
savings  at  the  time  of  admission  to  the  Hospital.  His  brother  earned  only  $6  a  week 
and  was  unable  to  help  him.  His  condition  indicated  subsequent  need  for  hospital 
treatment.    The  prognosis  was  unfavorable. 

Case  13.    A  native  of  Italy.    Age  18  years.    A  single  man. 

This  patient  landed  in  the  United  States  June  4.  1912,  and  came  to  New  York 
City  from  Pennsylvania  in  March,  1913.  It  seemed  probable  that  his  trouble  would 
deform  him.  His  medical  history  showed  that  he  had  empyema  in  August,  1912,  and 
that  since  then  his  health  had  been  in  a  bad  condition.  The  diagnosis  was  old 
empyema  with  fistula.  This  patient  had  been  treated  8  months  in  a  hospital  in  Penn- 
sylvania. He  had  no  relatives  in  this  country.  Since  his  arrival  in  this  country  he 
had  been  almost' continuously  a  public  charge.  It  was  strongly  probable  that  his  condi- 
tion originated  prior  to  landing.     The  prognosis  was  unfavorable. 

Case  14.    A  native  of  Ireland.    Age  32  years.    A  single  man. 

This  patient  landed  at  New  York  February  20,  1906.  The  diagnosis  was  chronic 
alcoholism.  It  could  not  be  determined  whether  he  had  been  a  chronic  alcoholic  prior 
to  landing.  He  had  been  out  of  work  5  weeks  at  admission  and,  though  he  claimed 
to  have  money  in  the  bank,  he  failed  to  pay  for  his  treatment  and  maintenance  in  the 
Hospital.    The  prognosis  for  cure  of  alcoholism  was  unfavorable. 

Case  15.    A  native  of  Germany.    Age  39  years.     A  widow. 

This  patient  landed  at  New  York  in  1900.  The  diagnosis  was  chronic  cardiac 
valvular  disease.  It  could  not  be  determined  whether  this  condition  existed  prior  to 
landing.  She  earned  $25  a  month  as  a  domestic  and  supported  a  daughter  7  years 
of  age.  She  had  no  other  relatives  in  this  country  and  no  savings.  The  prognosis 
was  unfavorable  and  indicated  recurrent  dependence. 

Case  16.    A  native  of  the  West  Indies.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  January  22,  1913.  The  diagnosis  was  pul- 
monary tuberculosis  and  acute  pneumatic  fever,  with  cardiac  complications.  He 
was  of  an  inherently  poor  constitution  and  seemed  likely  to  return  to  the  Hos- 
pital for  further  treatment.  He  had  no  savings  at  the  time  of  admission  and  had  no 
relatives  in  this  country.  The  prognosis  was  unfavorable.  He  was  discharged 
from  the  Hospital  after  8  days  stay  and  readmitted  3  days  later  with  the  same 
diagnosis. 

Case  17.    A  native  of  Russia.    Age  15  years.    A  girl. 

This  patient  landed  at  New  York  in  1910.  The  diagnosis  was  cerebro-spinal 
meningitis.  It  could  not  be  determined  whether  her  condition  was  due  to  causes  exist- 
ing prior  to  landing.  Her  parents  were  living  in  Russia.  She  had  an  aunt  in  Chi- 
cago, but  had  no  relatives  in  this  City.  She  had  been  working  in  a  shirtwaist  fac- 
tory and  earning  $5.00  per  week.     The  prognosis  was  unfavorable. 

Case  18.     A  native  of  Russia.    Age  32  years.    A  single  man. 

This  patient  landed  at  Boston  in  August,  1907.  He  came  to  New  Y'ork  on  his  way 
to  Europe  and  was  admitted  to  the  Hospital  on  the  day  of  arrival  here.    The  diagnosis 


222  HOSPITAL   COMMITTEE 

was  chronic  pulmonary  tuberculosis  and  chronic  pleurisy.  One  of  his  brothers  had 
died  of  tuberculosis.  It  could  not  be  determined  whether  his  condition  existed  prior 
to  landing.  He  had  money  for  passage  to  Europe,  but  could  not  pay  for  the  medical 
trentment  and  maintenance  he  received  at  the  Hospital.  The  prognosis  was  un- 
favorable. 

Case  19.    A  native  of  Ireland.    Age  23  years.    A  single  man. 

This  patient  landed  at  New  York  in  May,  1907.  The  diagnosis  was  chronic  pul- 
monary tuberculosis  and  alcoholism.  The  condition  probably  originated  prior  to  land- 
ing. He  had  been  out  of  employment  since  November,  1912.  His  parents  lived  in 
Ireland.    The  prognosis  was  unfavorable,  and  indicated  chronic  dependence. 

Case  20.     A  native  of  Spain.    Age  29  years.    A  single  man. 

This  patient  was  a  seaman  who  came  to  New  York  in  1912.  The  diagnosis  was 
cerebro-spinal  syphilis.  His  condition  probably  existed  prior  to  landing.  This  was  at 
least  his  second  admission  to  Bellevue.  He  had  been  out  of  work  a  number  of  weeks 
before  entering  the  Hospital  and  had  no  savings.  The  prognosis  was  unfavorable 
and  indicated  recurrent  or  chronic  dependence. 

Case  21.    A  native  of  Russia.    Age  33  years.    A  married  woman. 

The  patient  landed  in  the  United  States  in  May,  1904,  and  came  to  this  City  from 
New  Jersey  4  weeks  before  admission.  The  diagnosis  was  chronic  valvular  disease, 
existing  for  7  years  preceding  admission.  The  medical  history  showed  that  at  the  age 
of  17  she  had  an  attack  of  fever  lasting  5  weeks.  The  cardiac  condition  may  have 
existed  since  then,  and  certainly  existed  long  prior  to  coming  to  this  State.  This 
woman  had  been  treated  in  the  general  hospital  in  New  Jersey  for  a  period  of  6 
weeks.  Her  husband,  a  weaver,  had  been  unemployed  3  months  and  had  no  savings. 
There  were  4  dependent  children  in  the  family.  The  prognosis  was  unfavorable  and 
indicated  chronic  dependence. 

Case  22.    A  native  of  Ireland.    Age  60  years.    A  widower. 

This  patient  landed  in  the  United  States  in  September,  1881,  and  came  to  this  City 
from  Florida  May  24,  1913,  6  days  before  admission.  The  diagnosis  was  chronic  alco- 
holism, with  a  record  of  alcoholism  for  many  years,  probably  existing  prior  to  land- 
ing, and  certainly  prior  to  coming  to  this  State.  He  had  previously  been  a  patient  in 
Bellevue.  He  had  been  out  of  work  5  weeks  and  had  no  savings  at  the  time  of  ad- 
mission to  the  Hospital.    The  prognosis  was  unfavorable. 

Case  23.    A  native  of  Russia.    Age  19  years.    A  single  man. 

The  patient  landed  at  New  York  in  1910.  The  diagnosis  was  chronic  pulmonary 
tuberculosis.  It  could  not  be  determined  whether  his  condition  existed  prior  to  land- 
ing. He  had  been  out  of  work  for  some  time.  His  parents  were  living  in  Russia, 
and  his  sister,  the  only  relative  he  had  in  this  country,  was  unable  to  help  him.  The 
prognosis  was  unfavorable  and  indicated  recurrent  dependence. 

Case  24.    A  native  of  Roumania.    Age  58  years.    A  married  man. 

This  patient  landed  at  New  York  in  1903.  The  diagnosis  was  emphysema,  bron- 
chitis, and  myocarditis.  His  medical  history  showed  that  his  heart  had  exhibited  acute 
symptoms  of  poor  condition  for  at  least  3  years.  It  could  not  be  determined  that  his 
condition  existed  prior  to  landing.  This  man's  earnings  were  very  small.  He  had  a 
wife  to  support,  and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  He 
had  no  near  relatives.  The  prognosis  was  unfavorable  and  indicated  recurrent  and 
finally  chronic  dependence. 

Case  25.    A  native  of  Germany.    Age  54  years.    A  single  man. 

This  patient  landed  at  New  York  in  1887.  The  diagnosis  was  chronic  alcoholism, 
with  history  of  heavy  drinking  for  many  years.  This  man  had  been  unemployed  9 
weeks  and  had  no  savings.  He  was  transferred  to  a  chronic  hospital.  The  prognosis 
for  cure  was  unfavorable  and  indicated   recurrent  dependence. 

Case  26.    A  native  of  Ireland.    Age  33  years.    A  single  man. 

This  patient  landed  at  New  York  in  November,  191 1,  and  came  to  this  City  from 
New  Jersey  in  December,  1913.  The  diagnosis  was  alcoholic  poisoning.  His  medical 
history  showed  addiction  to  the  use  of  alcohol  since  arrival  in  this  country.  He  had 
no  relatives  in  the  United  States.  He  had  been  out  of  work  3  weeks  and  had  no  sav- 
ings.   The  prognosis  for  cure  was  unfavorable. 


ALIENS  AND   NON-RESIDENTS  223 

Case  27.    A  native  of  British  West  Indies.    Age  22  years.    A  single  man. 

This  patient  landed  at  New  York  in  igo6.  The  diagnosis  was  of  a  venereal  con- 
dition, which  had  previously  been  treated  at  Bellevue  Hospital.  His  medical  history 
did  not  show  that  the  condition  originated  prior  to  landing.  The  patient  had  been  out 
of  work  5  months  and  had  no  savings.  His  parents  were  living  in  the  West  Indies, 
and  his  sister,  the  only  relative  in  this  country,  could  give  him  no  assistance.  The 
prognosis  for  cure  was  unfavorable. 

Case  28.    A  native  of  Austria.    Age  43  years.    A  single  man. 

This  patient  landed  at  New  York  in  1904.  The  diagnosis  was  chronic  pulmonary 
tuberculosis.  He  was  transferred  to  a  chronic  hospital  in  an  unimproved  condition. 
The  history  did  not  show  that  this  trouble  originated  prior  to  coming  to  this  country. 
He  had  been  in  the  City  and  State  only  6  months  and  had  been  acutely  ill  before 
then.  He  had  been  out  of  work  8  months  and  had  no  savings.  His  brother,  living 
in  this  City,  was  unable  to  help  him.  The  prognosis  for  cure  was  unfavorable  and 
indicated  chronic  dependence. 

Case  29.     A  native  of  Russia.    Age  28  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1904.  The  diagnosis  was  chronic  pulmonary 
tuberculosis  and  tuberculous  glands  of  neck.  Her  physical  condition  was  very  poor. 
It  could  not  be  determined  that  her  condition  originated  prior  to  landing.  When 
working  she  had  earned  $6.00  per  week,  but  she  had  been  out  of  work  for  some  time 
and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  Her  brother  and  sister, 
living  in  this  country,  were  not  in  a  position  to  give  her  any  material  assistance.  Her 
father  lived  in  Russia.     The  prognosis  was  unfavorable. 

Case  30.     A  native  of  Venezuela.    Age  28  years.     A  single  man. 

This  patient  was  a  seaman,  discharged  at  New  York  in  October,  1912.  The  diag- 
nosis was  gonorrhea.  It  could  not  be  determined  whether  this  was  contracted  prior 
or  subsequent  to  landing.  This  man  had  no  savings  and  had  no  relatives  in  this 
country.    The  prognosis  was  unfavorable  and  indicated  recurrent  dependence. 

Case  31.    A  native  of  Ireland.    Age  44  years.    A  single  woman. 

This  patient  landed  at  New  York  in  June,  1894.  The  diagnosis  was  chronic  alco- 
holism, with  an  alcoholic  history  for  at  least  18  years.  This  was  at  least  her  third 
admission  to  the  alcoholic  ward  in  Bellevue.  She  had  also  been  treated  for  alcohol- 
ism in  another  public  hospital.  Her  sister,  also  an  habitual  alcoholic,  had  been  treated 
at  Bellevue.  This  woman  had  been  unemployed  for  2  months  prior  to  admission  to 
the  Hospital.     The  prognosis  was  unfavorable  and  indicated   recurrent  dependence. 

Case  32.    A  native  of  Ireland.     Age  40  years.    A  single  man. 

This  patient  landed  at  New  York  in  April,  1899.  The  diagnosis  was  chronic  pul- 
monary tuberculosis.  His  medical  history  showed  that  he  had  had  a  cough  for  25 
years.  The  general  condition  of  this  man's  health  was  very  poor.  He  had  no  rela- 
tives in  this  country  and  had  no  savings  at  the  time  of  admission  to  the  Hospital. 
His  parents  lived  in  Ireland.  He  was  transferred  to  a  tuberculosis  hospital.  The 
prognosis  was  unfavorable  and  indicated  chronic  invalidism. 

Case  33.    A  native  of  Germany.    Age  40  years.    A  single  man. 

This  patient  landed  at  New  York  in  May,  1903.  The  diagnosis  was  chronic 
cardiac  valvular  disease  and  chronic  alcoholism.  In  191 1  he  had  been  a  patient  for 
cardiac  disease  at_  a  public  hospital  for  2  months.  He  was  without  funds  and  had 
no  relatives  in  this  country.     The  prognosis  was  unfavorable. 

Case  34.    A  native  of  Russia.    Age  38  years.    A  married  man. 

This  patient  landed  at  Boston  in  1907.  He  was  admitted  to  the  Hospital  to  be 
operated  upon  for  inguinal  hernia.  He  also  had  advanced  pulmonary  tuberculosis, 
with  acute  attacks  during  2  years.  He  had  been  out  of  work  2  years  and  was  sup- 
ported by  his  wife.    The  prognosis  was  unfavorable  and  indicated  chronic  dependence. 

Case  35.    A  native  of  Ireland.    Age  49  years.     A  single  man. 

_  This  patient  landed  at  New  York  in  1883.  The  diagnosis  was  chronic  alcoholism. 
This  was  at  least  his  fifth  admission  to  the  alcoholic  ward  in  Bellevue.  The  medical 
history  showed  addiction  to  the  use  of  alcohol  ever  since  arrival  in  this  country. 
He  had  no  relatives  here  and  had  no  savings  at  the  time  of  admission  to  the  Hos- 
pital.    The  prognosis  was  unfavorable  and  indicated  subsequent  returns  to  a  hospital. 


224 


HOSPITAL   COMMITTEE 


Case  36.    A  native  of  Greece.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  August  10,  1911.  The  diagnosis  was  clironic 
gonorrhea  and  sciatica.  He  had  been  out  of  work  for  some  time  and  had  no  savings. 
His  parents  were  living  in  Greece  and  he  had  no  relatives  in  this  country.  The 
prognosis  was  unfavorable  and  indicated  that  the  patient  would  need  further  hospital 
treatment. 

Case  37.    A  native  of  Syria.     Age  32  years.     A  married  woman. 

This  patient  landed  at  New  York  in  July,  1909.  The  diagnosis  was  chronic 
nephritis.  It  could  not  be  determined  whether  the  condition  existed  prior  to  landing. 
She  was  also  a  chronic  cardiac.  This  woman  and  her  husband  kept  furnished  rooms, 
but  were  unable  to  meet  their  expenses  and  had  no  savings.  They  had  i  child  at 
school.     The  prognosis  was  unfavorable  and  indicated  recurrent  dependence. 

Case  38.     A  native  of  Ireland.    Age  40  years.     A  widow. 

This  patient  landed  at  New  York  in  November,  igo6.  The  diagnosis  was  chronic 
alcoholism.  This  was  at  least  her  seventh  admission  to  the  alcoholic  ward  at  Bellevue. 
She  had  2  children  under  14  years  of  age  who  were  maintained  in  an  institution  in 
Ireland.  She  had  no  relatives  in  this  country.  She  had  been  out  of  work  for  some 
time  and  had  no  savings.     The  prognosis  was  unfavorable. 

Case  39.    A  native  of  Austria.    Age  18  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1911.  The  diagnosis  was  exophthalmic  goitre. 
Her  general  condition  was  very  poor.  It  could  not  be  determined  whether  patient's 
condition  was  due  to  causes  existing  prior  to  landing.  She  had  no  relative  in  this 
country.  She  earned  very  little  when  employed  and  had  no  savings.  The  prognosis 
was  unfavorable  and  indicated  subsequent  returns  to  a  hospital. 

Case  40.     A  native  of  Ireland.     Age  25  years.     A  single  woman. 

This  patient  landed  at  New  York  September  11.  1910.  She  had  been  in  New 
York  State  and  City  only  5  weeks  prior  to  this  admission.  She  was  admitted  to  the 
Hospital  to  be  treated  for  after  effects  of  parturition.  The  diagnosis  was  chronic 
gonorrhea  and  involution  of  uterus.  This  patient  had  been  confined  in  another 
municipal  hospital  and  afterward  treated  in  still  another  before  admission  to  Bellevue. 
She  had  2  brothers  in  this  country,  I  living  in  Philadelphia  and  another  in  New 
Jersey.  She  was  removed  by  the  State  Board  of  Charities  to  Philadelphia,  Pa.  The 
prognosis   was   unfavorable. 

Case  41.    A  native  of  Germany.     Age  33  years.     A  single  man. 

This  patient  landed  at  New  York  in  1899.  The  diagnosis  was  chronic  pulmonary 
tuberculosis,  chronic  alcoholism,  and  multiple  neuritis.  Two  years  before  he  had 
been  in  a  municipal  hospital  for  tuberculosis.  This  was  at  least  his  second  admis- 
sion to  Bellevue.  He  was  alone  in  this  country  and  had  no  savings.  His  parents 
were  living  in  Germany.     The  prognosis  was  unfavorable. 

Case  42.     A  native  of  Ireland.    Age  22  years.     A  single  woman. 

This  patient  landed  at  New  York  in  October,  1910.  The  diagnosis  was  chronic 
pulmonary  tuberculosis.  It  could  not  be  determined  whether  her  condition  had  origi- 
nated prior  to  landing.  She  was  transferred  to  a  tuberculosis  hospital.  She  had  a 
sister  and  brother  in  this  country,  but  her  parents  were  living  in  Ireland.  The  prog- 
nosis was  unfavorable  and  indicated  chronic  dependence. 

Case  43.    A  native  of  England.     Age  30  years.     A  single  man. 

This  patient  landed  at  New  York  in  1903.  He  came  to  this  City  from  Albany, 
where  he  had  settled  on  the  day  of  admission  to  the  Hospital.  The  diagnosis  was 
chronic  alcoholism  and  fracture  of  skull.  He  had  been  unemployed  5  weeks  and 
had  no  savings.  He  had  no  relatives  in  this  country.  The  prognosis  for  alcoholism 
was  unfavorable. 

Case  44.     A  native  of  Italy.    Age  42  years.     A  single  man. 

This  patient  landed  at  New  York  August  9,  1909.  The  diagnosis  was  syphilis. 
The  patient  was  discharged  in  an  unimproved  condition  at  his  own  risk.  He  had  no 
relatives  in  the  United  States  and  had  no  savings  at  the  time  of  admission  to  the 
Hospital.     The  prognosis  was  unfavorable  and  indicated  recurrent  dependence. 


ALIENS  AND   NON-RESIDENTS  225 

Case  45.    A  native  of  Turkey.    Age  33  years.    A  married  man. 

This  patient  landed  at  New  York  in  June,  1911.  The  diagnosis  was  secondary 
syphilis,  apparently  contracted  subsequent  to  landing.  This  man  had  a  wife  and  2 
children  in  Turkey  dependent  upon  him  for  support.  He  had  no  relatives  here  and 
at  the  time  of  admission  to  the  Hospital  had  no  savings.  The  prognosis  was  un- 
favorable and  indicated  recurrent  dependence. 

Case  46.     A  native  of  Russia.     Age  29  years.    A  single  man. 

This  patient  landed  at  New  York  in  1903.  The  diagnosis  was  tuberculous 
arthritis,  of  12  months  existence.  His  medical  history  showed  that  he  had  had  an 
attack  of  gonorrhea  4  years  before.  He  had  no  relatives  in  the  United  States  and  had 
no  savings  at  the  time  of  admission  to  the  Hospital.  The  prognosis  was  unfavorable 
and  indicated  recurrent  dependence. 

Case  47.    A  native  of  Norway.    Age  60  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1905.  The  diagnosis  was  varicose  ulcer, 
with  previous  history  of  varicose  veins.  The  prognosis  was  unfavorable  and  indicated 
chronic  dependence. 

Case  48.    A  native  of  Austria.    Age  20  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1913.  She  was  admitted  to  the  Hospital  for 
a  fracture  of  the  hip  and  for  psychopathic  observation.  She  was,  however,  transferred 
to  a  chronic  hospital  for  further  treatment.  The  prognosis  was  unfavorable  and 
indicated  chronic  dependence. 

Case  49.    A  native  of  Ireland.     Age  23  years.    A  single  man. 

This  patient  landed  at  New  York  in  May,  1907.  The  diagnosis  was  chronic  pul- 
monary tuberculosis  and  chronic  alcoholism.  This  was  his  second  admission  to 
Bellevue.  The  condition  probably  originated  prior  to  landing.  He  had  been  out 
of  work  since  November,  1912.  His  parents  lived  in  Ireland.  He  was  transferred 
to  a  tuberculosis  hospital  for  further  treatment.  The  prognosis  was  unfavorable  and 
indicated  chronic  dependence. 

Case  50.     A  native  of  Austria.     Age  39  years.     A  married  man. 

This  patient  landed  at  New  York  March  18,  191 1.  The  diagnosis  was  pulmonary 
tuberculosis,  with  an  illness  of  8  weeks  before  admission.  This  man  had  been  out 
of  work  8  weeks  because  of  illness  and  had  no  savings.  He  had  a  wife  and  3 
children  dependent  upon  him  for  support.  The  prognosis  was  unfavorable  and  indi- 
cated recurrent  and   finally  chronic  dependence. 

CLASS  I-3C.    Aliens  Deportable  under  the  State  Charities  Law. — From  causes  exist- 
ing subsequent  to  landing. 

Case  i.    A  native  of  Hungary.    Age  19  years.    A  married  woman. 

This  patient  landed  at  New  York  in  December,  1909.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  9  months'  acute  illness.  She  had  numerous  cavities  in 
both  lungs.  She  had  come  to  the  City  from  New  Jersey  7  months  before  admission  to 
the  Hospital.  It  could  not  be  determined  whether  the  condition  originated  prior  to 
landing,  but  it  existed  prior  to  coming  to  New  York  State.  She  was  dependent  upon 
her  husband,  who  earned  $10.00  a  week.     The  prognosis  was  unfavorable. 

Case  2.    A  native  of  Ireland.     Age  28  years.     A  single  man. 

This  patient  landed  at  New  York  in  July,  1903.  He  had  been  in  New  York  is 
months  and  previously  was  in  Philadelphia.  The  diagnosis  was  gonorrheal  arthritis, 
affecting  a  number  of  joints.  _  He  had  previously  been  admitted  to  the  Hospital  and 
had  a  history  of  gonorrheal  infection  for  the  last  3^2  years.  His  condition  existed 
prior  to  his  coming  to  New  York  State.     The  prognosis  was  unfavorable. 

Case  3.    A  native  of  South  America.     Age  22  years.    A  single  man. 

This  patient  landed  at  New  York  in  1908.  The  diagnosis  was  gonorrheal  infec- 
tion, with  acute  arthritis.  This  patient  had  earned  $8.00  a  week  when  employed. 
The  prognosis  was  unfavorable. 


226  HOSPITAL   COMMITTEE 

Case  4.    A  native  of  Italy.     Age  37  years.    A  widower. 

This  patient  landed  at  New  York  in  December,  1909.  The  diagnosis  was  malaria, 
with  history  of  a  previous  attack.  His  parents  lived  in  Europe.  He  had  earned  $4.00 
a  week  when  employed,  but  he  had  been  unemployed  for  2  months  prior  to  admission. 
The  prognosis  indicated  possible  recurrent  dependence. 

Case  5.    A  native  of  Spain.     Age  41  years.     A  married  man. 

This  patient  landed  at  New  York  in  July,  1905.  The  diagnosis  was  hysteria.  He 
had  a  history  of  several  attempts  at  suicide,  and  was  in  delirium  when  admitted  to  the 
Hospital.  He  had  earned  $40.00  a  month  when  working.  His  wife  and  2  small 
children  were  in  Spain.     The  prognosis  was  unfavorable. 

Case  6.    A  native  of  Russia.    Age  32  years.    A  married  man. 

This  patient  landed  at  Philadelphia  in  igoo  and  had  been  in  New  York  City  only 

3  months.     The  diagnosis  was  gonorrheal  infection,  with  history  of  the  same  trouble 

4  years  prior  to  admission  and  syphilis  3  years  before.  This  patient  had  been  earning 
$15.00  a  week,  but  had  been  unemployed  for  2^  months.  The  prognosis  was  un- 
favorable. 

Case  7.    A  native  of  Russia.    Age  29  years.    A  married  man. 

This  patient  landed  at  New  York  in  1906.  The  diagnosis  was  chronic  articular 
rheumatism  of  4  months  existence.  He  had  been  in  a  municipal  hospital  6  months 
previously.  He  had  earned  $13.00  a  week  when  employed,  and  had  a  wife  and  a  small 
child  dependent  upon  him.     The  prognosis  was  unfavorable. 

Case  8.     A  native  of  Ireland.     Age  29  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1900.  The  diagnosis  was  chronic  alco- 
holism and  toxic  psychosis.  The  extent  of  her  alcoholic  history  could  not  be  deter- 
mined. Her  only  relative  in  this  country  was  a  brother.  The  prognosis  was  un- 
favorable. 

Case  9.    A  native  of  Russia.    Age  25  years.    A  married  man. 

This  patient  landed  at  New  York  in  March,  1906.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  acute  history  of  2  months.  He  was  transferred  to  a 
tuberculosis  hospital.  He  had  earned  $12.00  to  $16.00  a  week  when  employed,  but 
had  been  out  of  work  for  2  months.  He  had  a  wife  and  2  small  children  dependent 
upon  him.     The  prognosis  was  unfavorable. 

Case  id.    A  native  of  Norway.    Age  61  years.    A  married  man. 

This  patient  landed  at  New  York  as  a  seaman  in  1907  and  had  assumed  employ- 
ment on  dredges.  The  diagnosis  was  gastric  ulcer,  of  some  months  existence.  The 
prognosis  was  unfavorable. 

Case  ii.     A  native  of  Poland.    Age  28  years.     A  single  man. 

This  patient  landed  at  New  York  in  July,  1906.  The  diagnosis  was  chronic  pul- 
monary tuberculosis  and  alcoholism.  He  earned  $12.00  to  $16.00  a  week  when  em- 
ployed, but  had  been  ill  for  3  months  prior  to  admission.  His  only  relative  in  this 
country  was  a  brother,  earning  $11.00  a  week.     The  prognosis  was  unfavorable. 

Case  12.     A  native  of  Italy.    Age  24  years.    A  single  man. 

This  patient  landed  at  New  York  November  27,  1912.  The  diagnosis  was  gon- 
orrheal infection.  He  had  been  unable  to  work  for  3  weeks  prior  to  admission 
because  of  siclcness.    The  prognosis  was  unfavorable. 

Case  13.    A  native  of  Greece.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  in  February,  1908.  The  diagnosis  was  chronic 
pulmonary  tuberculosis.  He  had  lived  only  g  months  in  New  York  City  and  pre- 
viously had  been  in  Massachusetts  for  4  years.  All  his  relatives  were  in  Europe. 
He  had  earned  $10.00  a  week  when  employed.    The  prognosis  was  unfavorable. 

Case  14.    A  native  of  Australia.    Age  28  years.    A  single  man. 

This  patient  landed  at  New  York  in  December,  1903.  The  diagnosis  was  syphilis 
of  the  spinal  cord.  He  had  a  syphilitic  history  for  the  previous  3  years.  He  had 
been  employed  in  New  York  hospitals  for  2  months  previous  to  admission  and  prior 
to  that  time  had  been  4  years  in  Philadelphia.  All  his  relatives  were  in  England. 
He  had  no  savings.     The  prognosis  was  unfavorable. 


ALIENS  AND   NON-RESIDENTS  227 

Case  15.    A  native  of  Ireland.    Age  29  years.    A  single  man. 

This  patient  landed  at  New  York  in  October,  1902.  The  diagnosis  was  chronic 
alcoholism.  This  patient  was  a  "repeater"  at  this  Hospital.  He  had  made  $3.00  a  day 
as  a  blacksmith,  but  his  employment  was  irregular.     The  prognosis  was  unfavorable. 

Case  16.    A  native  of  Ireland.    Age  25  years.     A  single  woman. 

This  patient  landed  at  New  York  in  July,  1904.  She  was  pregnant,  although 
unmarried.  She  was  in  a  generally  poor  physical  condition  and  had  had  a  cough 
for  2  months.  She  had  earned  $14.00  a  month  and  board  as  a  domestic  when  em- 
ployed, but  had  been  unemployed  for  i  month  prior  to  admission  and  had  no  savings. 
She  had  previously  been  a  patient  in  a  municipal  hospital.  Her  mother  lived  in 
Ireland.  She  had  i  sister,  who  was  a  hotel  employee  in  New  York.  The  prognosis 
was  unfavorable. 

Case  17.    A  native  of  Russia.    Age  26  years.    A  married  man. 

This  patient  landed  at  New  York  in  _  April,  1908.  The  diagnosis  was  chronic 
interstitial  nephritis.  His  only  relative  in  this  country  was  a  brother.  His  father  lived 
in  Russia.     He  died  in  the  Hospital. 

Case  18.    A  native  of  Russia.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  in  August,  1908.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  history  of  3  months  prior  to  entering  the  Hospital. 
He  had  been  out  of  work  6  months  and  had  no  savings.  His  sister,  a  married  woman, 
was  the  only  relative  he  had  in  this  country.  His  parents  lived  in  Europe.  He  was 
transferred  to  a  tuberculosis  hospital  for  further  treatment.  The  prognosis  was  un- 
favorable. 

Case  ig.    A  native  of  Italy.    Age  35  years.    A  married  man. 

This  patient  landed  in  the  United  States  in  1905.  He  came  to  New  York  from 
Oklahoma  May  20,  1913,  on  his  way  back  to  Italy.  The  diagnosis  was  chronic  alco- 
holism and  chloral  poisoning.  While  in  an  intoxicated  condition  he  had  been  given 
chloral  poison  and  had  been  robbed.    The  prognosis  was  unfavorable. 

Case  20.    A  native  of  Greece.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  in  February,  1908.  The  diagnosis  was  chronic 
pulmonary  tuberculosis.  This  was  at  least  his  second  admission  to  Bellevue  Hospital. 
He  had  lived  only  9  months  in  Nev/  York  City,  and  previously  in  Massachusetts  for  4 
years.  All  his  relatives  were  in  Europe.  He  had  earned  $10.00  a  week  when  em- 
ployed.    The  prognosis  was  unfavorable. 

Case  21.    A  native  of  Ireland.    Age  65  years.    A  single  woman. 

This  patient  landed  at  New  York  about  1880.  The  diagnosis  was  chronic  paren- 
chyrnatous  nephritis  of  2  or  3  years  existence.  She  had  spent  2  winters  in  a  munici- 
pal institution.  She  had  no  means  of  making  a  livelihood  and  was  dependent  upon 
friends  and  public  charity.     The  prognosis  was  unfavorable. 

Case  22.    A  native  of  Russia.    Age  22  years.    A  single  man. 

This  patient  landed  at  New  York  in  June,  1907.  He  was  brought  to  the  Hospital 
by  a  representative^  of  the  State  Board  of  Charities.  The  diagnosis  was  chronic  pul- 
monary tuberculosis,  with  an  illness  of  about  2  years  existence.  He  was  to  be 
deported  May  24,  1913,  and  was  discharged  to  the  State  Board  of  Charities. 

Case  23.    A  native  of  Austria.    Age  26  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1906.  She  had  been  admitted  to  the  Hospital 
for  parturition.  She  was  out  of  employment  and  without  any  funds,  and  had  no  one 
in  this  country  who  could  give  her  any  assistance.  Her  mother  was  living  in  Europe. 
The  prognosis  was  unfavorable. 

Case  24.    A  native  of  Greece.    Age  30  years.     A  single  man. 

This  patient  landed  at  New  York  in  1907.  He  was  suffering  from  venereal  disease 
of  apparently  recent  history  and  a  lengthy  treatment  was  indicated  as  necessary.  He 
earned  $7.00  or  $8.00  a  week  when  employed,  but  had  no  savings  at  the  time  of  admis- 
sion to  the  Hospital.  He  had  no  relatives  in  this  country.  The  prognosis  was  un- 
favorable. 


'228  HOSPITAL   COMMITTEE 

Case  25.    A  native  of  Bermuda.    Age  39  years.    A  single  man. 

This  patient  landed  at  New  York  in  1901.  His  history  showed  that  he  had  had 
syphilis  for  s  years.  He  had  been  out  of  work  for  some  time  and  had  no  savings 
at  the  time  of  admission  to  the  Hospital.  He  had  no  relatives  in  this  country.  The 
prognosis  was  unfavorable. 

Case  26.    A  native  of  Ireland.     Age  36  years.     A  married  woman. 

This  patient  landed  at  New  York  in  1887.  The  diagnosis  was  chronic  alcoholism 
and  cardiac  valvular  disease.  She  had  no  knowledge  of  her  husband's  whereabouts 
and  had  no  other  relatives  in  this  country  excepting  a  small  child.  The  prognosis  was 
unfavorable. 

Case  27.     A  native  of  Ireland.    Age  40  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1907.  The  diagnosis  was  chronic  arthritis, 
involving  right  and  left  knees,  of  3  months  existence.  She  had  been  out  of  work  4 
months  before  admission  to  the  Hospital.  She  had  no  savings  and  had  no  relatives 
in  this  country.    The  prognosis  was  unfavorable. 

Case  28.    A  native  of  Ireland.     Age  34  years.    A  married  woman. 

This  patient  landed  at  New  York  May  2,  1901.  She  was  separated  from  her 
husband.  The  diagnosis  was  chronic  alcoholism.  She  had  been  addicted  to  the  use 
of  alcohol  for  a  few  years.  She  had  no  steady  occupation.  Her  income  was  un- 
certain and  upon  admission  to  the  Hospital  she  had  no  savings.  Her  child,  6  years 
old,  was  in  a  charitable  institution.    The  prognosis  was  unfavorable. 

Case  29.    A  native  of  Ireland.    Age  56  years.    A  single  man. 

This  patient  landed  at  New  York  in  1902.  The  diagnosis  was  chronic  alcoholism. 
This  was  at  least  the  second  instance  of  the  patient's  dependence.  He  earned  $5.00 
a  week  when  employed,  but  had  no  funds  at  the  time  of  admission  to  the  Hospital. 
He  had  no  relatives  in  the  United  States.    The  prognosis  was  unfavorable. 

Case  30.    A  native  of  West  Indies.    Age  28  years.    A  single  man. 

This  patient  landed  at  New  York  in  April,  1906.  The  diagnosis  was  chronic 
pulmonary  tuberculosis.  His  illness  had  been  acute  for  6  months  before  entering 
the  Hospital,  which  prevented  him  from  doing  any  work.  He  had  no  savings.  His 
brother  in  this  country  was  too  poor  to  give  him  any  material  assistance.  The  prog- 
nosis was  unfavorable. 

Case  31.    A  native  of  Ireland.    Age  28  years.     A  single  man. 

This  patient  landed  at  New  York  in  September,  1901,  and  came  to  this  State 
from  Ohio  in  1913.  The  diagnosis  was  chronic  alcoholism,  with  an  alcoholic  history 
for  8  years.  He  had  been  out  of  work  for  some  time  and  had  no  savings  at  the  time 
of  admission  to  the  Hospital.  He  had  no  relatives  in  this  country.  The  prognosis 
was  unfavorable. 

Case  32.     A  native  of  Ireland.      Age  27  years.     A  single  man. 

This  patient  landed  at  Boston  in  1903  and  came  to  New  York  from  Boston  3 
days  before  admission  to  the  Hospital.  The  diagnosis  was  chronic  alcoholism.  He 
had  been  addicted  to  the  use  of  alcohol  for  some  time  and  at  one  time  had  been  a 
patient  in  the  public  hospital  in  Boston  with  delirium  tremens.  He  had  been  out  of 
work  and  had  no  savings.    His  sister  lived  in  Boston.     The  prognosis  was  unfavorable. 

Case  33.    A  native  of  Ireland.     Age  35  years.    A  single  man. 

This  patient  landed  in  the  United  States  in  1897.  In  May,  1913,  he  came  to  this 
City  from  New  Jersey,  where  he  had  lived  for  8  years.  The  diagnosis  was  fracture 
of  the  vertebrae,  received  on  the  day  of  admission  to  the  Hospital.  He  had  been  out 
of  work  for  2  weeks  prior  to  admission  to  the  Hospital  and  had  no  savings. 
He  had  no  relatives  in  this  country.     The  prognosis  was   unfavorable. 

Case  34.    A  native  of  Russia.    Age  47  years.    A  married  man. 

This  patient  landed  at  Quebec,  Canada,  in  1909  and  came  directly  to  settle  in  New 
York  City.  The  diagnosis  was  chronic  pulmonary  tuberculosis,  with  a  history  of  I 
year  of  acute  illness.  After  a  short  stay  in  the  Hospital  he  was  transferred  to  a  tuber- 
culosis hospital.  He  had  been  out  of  work  for  6  weeks  before  entering  Bellevue 
Hospital.  His  wife  and  5  minor  children,  under  13  years,  living  in  Europe,  were 
dependent  upon  him  for  support.     He  had  no  savings  and  had  no  relatives  in  this 


ALIENS  AND   NON-RESIDENTS  229 

country.    He   was   deported   by  the   State   Board   of   Charities.     The   prognosis   was 
unfavorable. 

Case  35.    A  native  of  Russia.    Age  21  years.     A  single  woman. 

This  patient  landed  at  New  York  in  October,  1910.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  a  history  of  2  years  existence.  During  almost  all  of 
this  time  she  had  been  an  inmate  of  a  tuberculosis  institution.  She  had  been  out  of 
employment  since  191 1.  She  was  transferred  from  Bellevue  to  a  tuberculosis  hospital. 
Her  parents  were  dead.  One  sister  earned  $8.00  a  week,  another  sister  was  a  tuber- 
culosis patient,  and  a  younger  sister  was  in  a  home.    The  prognosis  was  unfavorable. 

Case  z6-    A  native  of  Greece.     Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  in  February,  1908.  The  diagnosis  was  chronic 
pulmonary  tuberculosis.  This  was  at  least  his  second  admission  to  Bellevue  Hospital. 
He  had  lived  only  9  months  in  New  York  City  and  previously  had  been  in  Massa- 
chusetts for  4  years.  All  of  his  relatives  were  in  Europe.  He  earned  $10.00  a  week 
when  employed.     The  prognosis  was  unfavorable. 

Case  37.    A  native  of  Russia.    Age  24  years.    A  single  man. 

This  patient  landed  at  New  York  in  1910.  The  diagnosis  was  venereal  disease,  of 
recent  contraction.  He  had  no  relatives  in  this  country  and  had  no  savings  at  the 
time  of  admission  to  the  Hospital.     The  prognosis  was  unfavorable. 

Case  38.    A  native  of  Germany.     Age  30  years.    A  single  man. 

This  patient  landed  at  New  York  in  July,  1911.  The  diagnosis  was  acute  rheu- 
matic fever.  He  had  9  days  previously  been  discharged  from  a  hospital  after  5  weeks 
treatment  for  rheumatism.  This  man  had  no  relatives  in  this  country  and  no  sav- 
ings, as  he  had  been  out  of  work  for  some  time.    The  prognosis  was  unfavorable. 

Case  39.    A  native  of  England.     Age  26  years.     A  widow. 

This  patient  landed  at  New  York  in  September,  1905.  The  diagnosis  was  chronic 
pulmonary  tuberculosis.  She  had  been  working  in  the  millinery  trade  and  supporting 
herself  and  5-year-old  child.  She  had  no  savings  at  the  time  of  admission  to  the 
Hospital.  The  only  relative  in  this  country  was  a  sister  who  earned  $6.00  a  week. 
Her  father  lived  in  England.    The  prognosis  was  unfavorable. 

Case  40.    A  native  of  Scotland.    Age  24  years.     A  married  man. 

This  patient  landed  at  New  York  in  1904.  The  diagnosis  was  secondary  syphilis, 
with  a  history  of  3  months  existence.  He  also  had  cardiac  disease.  This  was  at 
least  his  second  admission  to  Bellevue  Hospital.  He  had  no  savings.  He  had  2  mar- 
ried brothers  and  i  sister,  a  silk  weaver,  in  this  country.  His  parents  were  living  in 
Scotland.    The  prognosis  was  unfavoraljle. 

Case  41.    A  native  of  Russia.    Age  unknown.    A  single  man. 

This  patient  landed  at  New  York  in  July,  1910.  The  diagnosis  was  chronic  pul- 
monary tuberculosis,  with  a  history  of  6  weeks  acute  illness.  He  was  transferred  to 
a  tuberculosis  hospital.  He  had  been  out  of  work  3  months  prior  to  admission  to 
the  Hospital  and  had  no  savings.  He  had  3  brothers  and  a  married  sister  in  this 
country.     His  parents  were  living  in  Europe.    The  prognosis  was  unfavorable. 

Case  42.    A  native  of  Ireland.    Age  34  years.    A  single  man. 

This  patient  landed  at  New  York  in  September,  1901.  The  diagnosis  was  chronic 
alcoholic  poisoning,  with  an  alcoholic  history  for  9  years.  This  man  had  been  out  of 
work  4  months  and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  The 
prognosis  was  unfavorable. 

Case  43.    A  native  of  Greece.    Age  32  years.    A  single  man. 

This  patient  landed  at  New  York  June  5,  1910.  The  diagnosis  was  pulmonary 
tuberculosis,  with  a  history  of  acute  illness  for  6  months.  He  was  transferred  to  a 
tuberculosis  hospital.  He  had  no  relatives  in  this  country  and  had  been  out  of  work 
4  months.  He  expressed  a  desire  to  be  returned  to  Italy.  The  prognosis  was  un- 
favorable. 

Case  44.    A  native  of  Ireland.    Age  37  years.     A  single  man. 

_  This  patient  landed   at  New  York  June  7,    1908.     The   diagnosis   was   alcoholic 
poisonmg  and  old  mastoiditis.     He  had  been  an  inmate  of  a  municipal  hospital  for  11 


230  HOSPITAL   COMMITTEE 

weeks  for  an  operation.     He  had  no  savings.     He  had  i   brother,  a  laborer,  in  the 
City.    The  prognosis  was  unfavorable. 

Case  45.    A  native  of  Germany.    Age  24  years.     A  single  man. 

This  patient  landed  at  New  York  as  a  discharged  seaman  in  March,  1909.  He 
lived  in  various  states  and  came  to  New  York  a  few  months  before  admission  to  the 
Hospital.  The  diagnosis  was  subacute  rheumatism  with  cardiac  involvement.  The 
history  showed  that  he  had  been  treated  at  Bellevue  on  a  previous  occasion  for  the 
same  ailment  He  had  been  out  of  work  for  a  length  of  time  and  had  no  savings. 
The  prognosis  was  unfavorable. 

Case  46.    A  native  of  Ireland.    Age  25  years.    A  single  man. 

This  patient  landed  at  New  York  in  April,  1908.  The  diagnosis  was  pulmonary 
tuberculosis.  He  had  no  savings  at  the  time  of  admission  to  the  Hospital  and  had 
no  relatives  in  this  country.     The  prognosis  was  unfavorable. 

Case  47.     A  native  of  Germany.    Age  41  years.     A  single  man. 

This  patient  landed  at  New  York  about  1893.  The  diagnosis  was  epilepsy.  The 
history  showed  that  he  had  been  an  inmate  of  a  municipal  hospital  for  8  months. 
He  had  been  unable  to  earn  his  living  for  the  past  3  years.  He  lived  in  lodging 
houses.  His  only  relative  in  this  country  was  a  brother.  The  prognosis  was  un- 
favorable. 

Case  48.    A  native  of  Austria.    Age  25  years.    A  single  man. 

This  patient  landed  at  New  York  in  May,  1903.  The  diagnosis  was  gonorrheal 
infection  and  syphilis,  with  a  syphilitic  history  for  the  previous  6  years.  This  man 
was  a  recurrent  dependent  and  had  been  in  Bellevue  Hospital  previously.  He  was 
transferred  to  a  chronic  hospital.  He  had  been  unemployed  3  months  and  had  no 
savings.  His  only  relative  in  this  country  was  a  sister,  who  was  working  in  a  fac- 
tory.    His  parents  lived  in  Europe.     The  prognosis  was  unfavorable. 

Case  49.    A  native  of  Ireland.    Age  40  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1888.  The  diagnosis  was  chronic  alcoholism 
and  fracture  of  femur.  The  alcoholic  history  covered  many  years.  She  was  a  recur- 
rent dependent  and  also  had  a  workhouse  record.  She  was  a  domestic  irregularly 
employed.     She  had  no  relatives  in  this  country.     The  prognosis  was  unfavorable. 

Case  50.    A  native  of  Ireland.     Age  45  years.    A  single  man. 

This  patient  landed  at  New  York  in  1899.  The  diagnosis  was  syphilis,  with  a 
syphilitic  history  for  7  years,  and  chronic  gonorrhea.  He  was  transferred  to  a  chronic 
hospital.  He  lived  in  lodging  houses.  The  only  relative  in  this  country  was  a 
brother,  who  was  out  West.     The  prognosis  was  unfavorable. 

Case  si-    A  native  of  Italy.    Age  40  years.    A  single  man. 

This  patient  landed  at  New  York  in  September,  1899.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  a  history  of  4  weeks  acute  illness.  He  was  transferred 
to  a  chronic  hospital.  He  had  been  out  of  work  4^  months  and  had  no  savings  at 
the  time  of  admission  to  the  Hospital.  He  had  2  married  sisters  in  this  country. 
His  parents  were  living  in  Europe.    The  prognosis  was  unfavorable. 

Case  52.    A  native  of  Austria.    Age  18  years.    A  single  woman. 

This  patient  landed  at  New  York  in  May,  1912.  The  diagnosis  was  pregnancy,  of 
a  few  weeks  existence.  She  had  been  out  of  work  for  some  time  and  had  no 
savings  at  the  time  of  admission  to  the  Hospital.  Her  parents  lived  in  Europe  and 
she  had  no  relatives  in  this  country.     The  prognosis  was  favorable. 

Case  53.     A  native  of  Russia.    Age  30  years.    A  married  man. 

This  patient  landed  at  New  York  in  April,  1911.  He  came  to  this  City  from 
Paterson  to  be  admitted  to  the  Hospital.  The  diagnosis  was  chronic  gonorrhea 
and  inguinal  abscess,  with  a  history  of  contraction  of  8  months  before.  He  was 
transferred  to  a  chronic  hospital.  He  had  a  wife  dependent  upon  him  for  support 
and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  The  prognosis  was 
unfavorable. 


ALIENS  AND   NON-RESIDENTS  231 

Case  54.    A  native  of  Scotland.     Age  38  years.     A  married  woman,  separated  from 

her  husband. 

This  patient  landed  at  New  York,  December,  1899.  The  diagnosis  was  secondary 
syphilis,  with  a  syphilitic  history  for  3  months.  She  had  been  out  of  work  for  2 
weeks  prior  to  admission  to  the  Hospital  and  had  no  savings.  The  prognosis  was 
unfavorable. 

Case  55.    A  native  of  Russia.     Age  28  years.     A  single  man. 

This  patient  landed  at  New  York  in  May,  1905.  The  diagnosis  was  chronic  alco- 
holism. He  had  been  a  patient  in  a  public  hospital  for  2  months  at  a  previous  time. 
His  parents  were  living  in  Russia.  He  had  2  brothers,  who  were  laborers,  living 
in  this  country.     The  prognosis  was  unfavorable. 

Case  56.    A  native  of  Russia.     Age  32  years.     A  single  man. 

This  patient  landed  at  New  York  in  April,  1908.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  a  history  of  8  months  of  acute  symptoms.  This  patient 
had  been  unemployed  for  about  4  months  prior  to  admission  to  the  Hospital  and  had 
no  savings.  The  only  relative  in  this  country  was  a  brother.  The  prognosis  was 
unfavorable. 

Case  57.     A  native  of  Italy.     Age  28  years.     A  single  man. 

This  patient  landed  at  New  York  in  October,  1901.  He  had  lived  in  New  York 
City  only  6  months  before  admission  to  the  Hospital.  The  diagnosis  was  chronic 
alcoholism,  with  an  alcoholic  history  for  6  years.  He  had  previously  been  in  Bellevue 
for  alcoholism.  This  patient  was  irregularly  employed  and  had  no  savings  at  the 
time  of  admission  to  the  Hospital.  The  only  relatives  in  this  country  were  2  brothers 
in  Montana.    The  prognosis  was  unfavorable. 

Case  58.    A  native  of  Italy.     Age  26  years.    A  single  man. 

This  patient  landed  at  New  York  in  March,  1910.  The  diagnosis  was  pulmonary 
tuberculosis,  with  a  history  of  acute  symptoms  for  2  months.  He  was  transferred  to 
a  chronic  hospital.  He  had  earned  $8.00  a  week  when  employed.  He  had  been  out 
of  work  for  some  time  and  had  no  savings  at  the  time  of  admission  to  the  Hospital. 
All  of  his  relatives  were  living  in  Europe.     The  prognosis  was  unfavorable. 

Case  59.     A  native  of  Russia.    Age  22  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1906.  The  diagnosis  was  chronic  gastric 
neurasthenia  and  prolapse  of  the  internal  organs.  The  history  showed  that  she 
had  had  gastric  trouble  for  the  preceding  4  years.  She  had  an  operation  in  1910, 
and  2  subsequent  operations  for  adhesions.  She  had  been  out  of  work  6  months 
and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  She  had  been  treated 
at  Bellevue  Hospital  on  a  previous  occasion.  The  only  relative  in  this  country  was  a 
sister,  who  earned  very  little.  Her  parents  were  living  in  Russia.  The  prognosis  was 
unfavorable. 

Case  60.    A  native  of  Ireland.    Age  46  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1887.  The  diagnosis  was  chronic  alcoholism 
of  undetermined  extent.  She  had  no  regular  occupation  and  had  no  relatives  in  this 
country.  At  time  of  admission  to  the  Hospital  she  had  no  savings.  The  prognosis 
was  unfavorable. 

Case  61.     A  native  of  Italy.    Age  23  years.    A  single  man. 

This  patient  landed  at  New  York  in  August,  1912.  The  diagnosis  was  acute 
pericarditis  and  acute  rheumatic  fever.  He  had  2  sisters  in  this  country.  At  the 
time  of  admission  to  the  Hospital  he  had  no  savings.    The  prognosis  was  unfavorable. 

Case  62.    A  native  of  Germany.     Age  21  years.    A  single  woman. 

This  patient  landed  at  New  York  in  December,  1910.  The  diagnosis  was  abortion. 
Her  mother  and  6  brothers  lived  in  Europe.  A  brother  was  the  only  relative  in  this 
country.    The  medical  prognosis  was  favorable. 

Case  63.    A  native  of  Russia.     Age  30  years.     A  single  man. 

This  patient  landed  at  New  York  in  1908  as  a  second-class  passenger.  The 
diagnosis  was  syphilis,  with  a  history  of  6  weeks  existence.  He  had  earned  $9.00 
a  week,  but  at  the  time  of  admission  to  the  Hospital  he  had  been  out  of  work  2 


2Z2 


HOSPITAL   COMMITTEE 


weeks.    He  had  been  admitted  previously  to  the  Hospital.    He  had  no  relatives  in  this 
country.     The  prognosis  was  unfavorable. 

Case  64.    A  native  of  Ireland.    Age  28  years.    A  single  man. 

This  patient  landed  at  New  York  in  August,  1901.  The  diagnosis  was  chronic 
alcoholism,  with  an  alcoholic  history  for  9  years.  He  had  been  out  of  work  7  weeks 
and  had  no  savings.  His  brother,  a  bartender,  was  the  only  relative  living  in  this 
country.    His  parents  were  living  in  Ireland.    The  prognosis  was  unfavorable. 

Case  65.    A  native  of  Austria.    Age  19  years.     A  single  woman. 

This  patient  landed  at  New  York  March  6,  1912.  The  diagnosis  was  acute 
rheumatism  and  acute  endocarditis.  Her  parents  were  living  in  Austria.  She  had 
I  sister  in  this  City,  a  domestic,  earning  $4.00  a  week.  She  had  been  out  of 
work  for  2  weeks  prior  to  admission  to  the  Hospital.  The  prognosis  was  unfavor- 
able. 

Case  66.     A  native  of  Russia.    Age  30  years.    A  married  man. 

This  patient  landed  at  New  York  in  1910.  The  diagnosis  was  chronic  pulmonary 
tuberculosis.  He  had  been  acutely  ill  for  about  7  months.  He  had  been  unemployed 
for  2  months  prior  to  admission  to  the  Hospital.  His  wife  was  dependent  upon  him 
for  support.     The  prognosis  was  unfavorable. 

Case  6y.    A  native  of  Italy.    Age  27  years.     A  single  man. 

This  patient  landed  at  New  York  in  1903.  The  diagnosis  was  chronic  pulmonary 
tuberculosis  with  tubercular  laryngitis,  with  a  history  of  5  months  acute  illness.  He 
was  a  chronic  invalid.  He  had  been  out  of  work  for  6  months  before  admission  to 
the  Hospital  and  had  no  savings.  His  parents  were  living  in  Italy.  He  had  no 
relatives  in  this  country.    The  prognosis  was  unfavorable. 

Case  68.    A  native  of  Ireland.    Age  40  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1897.  The  diagnosis  was  alcoholism,  with  a 
history  of  at  least  5  admissions  to  the  alcoholic  ward  at  Bellevue.  This  patient  had 
been  out  of  work  for  at  least  3  weeks  and  had  no  savings.  The  only  relative  in  this 
country  was  a  brother.  Her  mother  was  living  in  Ireland.  The  prognosis  was 
unfavorable. 

Case  69.     A  native  of  Spain.     Age  23  years.    A  single  woman. 

This  patient  landed  at  New  York  February  22,  1912.  The  diagnosis  was  par- 
turition. She  had  been  out  of  work  for  some  time  before  admission  to  the  Hos- 
pital and  had  no  savings.  Her  mother  was  living  in  Spain.  The  medical  prognosis 
was  favorable. 

Case  70.    A  native  of  Germany.    Age  37  years.    A  single  man. 

This  patient  landed  at  New  York  December  29,  1894.  The  diagnosis  was  loco- 
motor ataxia  with  cerebro-spinal  syphilis.  The  history  showed  gonorrheal  infection 
14  years  before  and  syphilis  infection  9  years  before.  He  had  no  relatives  in  this 
country.  His  parents  were  living  in  Germany.  He  had  no  savings  at  the  time  of 
admission  to  the  Hospital.     The  prognosis  was  unfavorable. 

Case  71.     A  native  of  Russia.    Age  24  years.     A  single  man. 

This  patient  landed  at  San  Francisco,  California,  in  August,  1908.  He  had  been 
in  New  York  State  only  10  months  and  in  the  City  only  3  months  before  admission 
to  the  Hospital.  The  diagnosis  was  malaria  and  quinine  poisoning.  The  history 
showed  that  he  had  a  similar  condition  a  year  before.  He  had  been  out  of  work  3 
months  and  was  unable  to  pay  for  the  medical  treatment  and  maintenance  he  received 
at  the  Hospital.     The  prognosis  was  unfavorable. 

Case  72.    A  native  of  Austria.    Age  29  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1904.  The  diagnosis  was  parturition.  She 
already  had  a  child  S  years  old.  She  had  no  savings  at  the  time  of  admission  to  the 
Hospital  and  had  no  relatives  other  than  her  child  in  this  country.  Her  parents  were 
living  in  Austria.     The  medical  prognosis  was  favorable. 

Case  73.    A  native  of  Ireland.    Age  47  years.    A  single  man. 

This  patient  landed  at  New  York  in  1888.  The  diagnosis  was  chronic  alcoholism, 
with  an  alcoholic  history  for  many  years.     He  had  no  savings  at  time  of  admission  to 


ALIENS  AND   NON-RESIDENTS  233 

the  Hospital.     This  patient  had  i  married  sister  in  this  country.     The  prognosis  was 
unfavorable. 

Case  74.    A  native  of  Hungary.    Age  25  years.     A  single  man. 

This  patient  landed  at  New  York  January  5,  1907.  The  diagnosis  was  neuras- 
thenia. He  had  earned  only  $8.00  a  week  when  employed.  He  had  no  relatives  in  this 
country.    His  parents  were  living  in  Hungary.     The  prognosis  was  unfavorable. 

Case  75.     A  native  of  Germany.    Age  51  years.     A  single  man. 

This  patient  landed  at  New  York  in  188S.  He  came  from  New  Jersey,  where  he 
had  his  residence.  The  diagnosis  was  chronic  pulmonary  tuberculosis,  with  a  tuber- 
cular history  for  S  years  and  a  record  of  6  admissions  to  one  New  York  tuberculosis 
hospital.  This  patient  had  been  unemployed  for  a  year  and  a  dependent  on  charity. 
He  had  no  relatives  in  this  country.     The  prognosis  was  unfavorable. 

Case  76.     A  native  of  Ireland.    Age  65  years.     A  single  woman. 

This  patient  landed  at  New  York  about  1858.  She  came  from  New  Jersey,  where 
she  had  settled  prior  to  admission  to  the  Hospital.  The  diagnosis  was  chronic  pul- 
monary tuberculosis,  with  a  history  of  several  years  existence.  She  had  been  pre- 
viously admitted  for  the  same  disease  at  Bellevue  Hospital  and  other  hospitals.  She 
had  been  unable  to  work  for  a  year  and  had  no  relatives  in  this  country.  The  prog- 
nosis was  unfavorable. 

Case  77.    A  native  of  Italy.    Age  25  years.    A  married  woman. 

This  patient  landed  at  New  York  in  September,  1910.  The  diagnosis  was  chronic 
pulmonary  tuberculosis.  She  was  transferred  to  a  tuberculosis  hospital.  She  had  2 
small  childrea  Her  husband  was  unable  to  pay  for  the  medical  treatment  and  main- 
tenance she  received  at  the  Hospital.     The  prognosis  was  unfavorable. 

Case  78.    A  native  of  Austria.    Age  39  years.     A  widow. 

This  patient  landed  at  New  York  in  igoi.  The  diagnosis  was  chronic  alcoholism, 
with  an  alcoholic  history  for  6  years.  She  was  a  domestic  and  had  no  savings  at  the 
time  of  admission  to  the  Hospital.  She  had  been  previously  admitted  to  Bellevue 
for  alcoholism.     She  had  no  relatives  in  this  country.     The  prognosis  was  unfavorable. 

Case  79.     A  native  of  Ireland.     Age  58  years.    A  single  woman. 

This  patient  landed  at  New  York  about  igoo.  The  diagnosis  was  chronic  poly- 
arthritis. She  had  previously  been  treated  at  a  public  hospital  in  New  York.  She 
had  been  unable  to  work  steadily  for  the  last  10  years  because  of  the  condition 
of  her  health.  She  had  no  relatives  in  this  country  and  had  lost  all  of  her  savings. 
The  prognosis  was  unfavorable. 

Case  80.    A  native  of  India.     Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  January  22,  1913,  as  a  second-class  passenger. 
The  diagnosis  was  acute  rheumatic  fever  with  myo-endocarditis.  This  was  his  second 
admission  to  Bellevue.  He  had  been  out  of  work  3  weeks  and  had  no  savings.  He 
had  no  relatives  in  this  country.     The  prognosis  was  unfavorable. 

Case  81.    A  native  of  Austria.     Age  20  years.     A  single  woman. 

This  patient  landed  at  New  York  in  March,  191 1.  The  diagnosis  was  pregnancy. 
She  had  been  out  of  work  5  months  prior  to  admission  to  the  Hospital  and  had  no 
savings.  Her  father  lived  in  Perth  Amboy,  N.  J.  Her  mother  was  living  in  Austria. 
The  medical  prognosis  was  favorable. 

Case  82.     A  native  of  Hungary.     Age  50  years.     A  widow. 

This  patient  landed  at  New  York  August  18,  191 1.  The  diagnosis  was  hysteria 
and  old  fracture  of  hip  joint.  She  walked  on  crutches.  She  had  previously  been  an 
inmate  of  numerous  City  institutions.  Her  employment  was  irregular.  She  had  no 
savings  and  no  relatives  in  this  country.     The  prognosis  was  unfavorable. 

Case  83.     A  native  of  Ireland.    Age  32  years.     A  single  man. 

_  This  patient  landed  at  New  York  in  April,  1903.  The  diagnosis  was  alcoholism, 
with  delirium  tremens  and  cirrhosis  of  liver.  The  history  showed  that  he  had  pre- 
viously been  in  the  alcoholic  ward  at  Bellevue.     He  had  been  out  of  work  3  weeks 


234  HOSPITAL  COMMITTEE 

and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  He  had  2  brothers 
living  in  New  York.  His  mother  was  living  in  Ireland.  The  prognosis  was  un- 
favorable. 

Case  84.     A  native  of  Ireland.    Age  35  years.    A  single  woman. 

This  patient  landed  at  New  York  in  September,  1897.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  a  history  indicating  that  the  disease  was  contracted  sub- 
sequent to  landing.  She  had  been  a  patient  for  3  months  in  a  tuberculosis  hospital. 
She  was  without  any  means  of  support.  She  had  i  married  sister  in  this  country.  Her 
father  was  living  in  Ireland.     The  prognosis  was  unfavorable. 

Case  85.     A  native  of  Austria.     Age  19  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1907.  The  diagnosis  was  hysteria.  The  his- 
tory indicated  unstable  mentality.  She  had  3  previous  admissions  to  Bellevue  and  4 
to  other  public  hospitals.  She  had  a  sister  and  brother  in  this  country.  Her  parents 
were  living  in  Austria.     The  prognosis  was  unfavorable. 

Case  86.    A  native  of  Turkey.    Age  24  years.     A  single  man. 

This  patient  landed  at  New  York  in  1898.  He  came  to  New  York  from  New 
Jersey,  where  he  resided,  the  day  of  admission  to  the  Hospital.  He  had  never  lived 
in  New  York.  The  diagnosis  was  tenosynovitis,  with  a  history  of  7  years  existence. 
He  was  discharged  in  an  unimproved  condition  and  returned  to  the  Hospital  a  week 
later.  He  earned  $IS-7S  a  week,  but  had  no  savings.  His  parents  were  dependent 
upon  him.     The  prognosis  was  unfavorable. 

Case  87.     A  native  of  Ireland.    Age  24  years.     A  widow. 

This  patient  landed  at  New  York  in  1904.  The  diagnosis  was  pregnancy.  She 
had  2  children  dependent  upon  her  for  support.  Before  admission  to  the  Hospital 
she  worked  in  a  pencil  factory  and  earned  $5.00  a  week.  Her  parents  were  living  in 
Ireland.  A  brother,  who  earned  very  little,  was  the  only  relative  in  this  country. 
The  medical  prognosis  was  favorable. 

Case  88.    A  native  of  Italy.    Age  24  years.    A  single  man. 

This  patient  landed  at  New  York  in  1907.  The  diagnosis  was  tuberculosis  of 
genital  organs,  which  the  history  indicated  had  apparently  been  of  recent  origin. 
He  had  earned  only  $10.00  a  week  when  employed.  He  did  not  know  the  where- 
abouts of  his  sister  and  brother,  who  were  living  in  this  country.  The  prognosis 
was  unfavorable. 

Case  89.    A  native  of  Russia.     Age  21  years.    A  single  woman. 

This  patient  landed  at  New  York  in  April,  1906.  The  diagnosis  was  carcinoma 
of  rectum  and  almost  the  entire  genito-urinary  system.  The  patient  also  had  an 
artificial  anus.  She  had  previously  been  a  patient  for  4  months  in  a  public  hospital. 
The  history  showed  that  her  condition  had  originated  at  least  2  years  before.  She 
had  been  out  of  work  since  1910.  She  lived  with  her  parents  in  this  country,  but 
they  were  unable  to  pay  for  the  medical  treatment  she  received  at  the  Hospital. 
There  were  6  in  the  family  and  the  income  was  $10.00  a  week,  with  $3.00  a  month 
from  a  lodger.  She  was  transferred  in  an  unimproved  condition  to  a  chronic  hos- 
pital.   The  prognosis  was  unfavorable. 

Case  90.    A  native  of  Germany.    Age  unknown.     A  single  man. 

This  patient  landed  at  New  York  in  1902.  The  diagrnosis  was  pulmonary  tuber- 
culosis, with  a  history  of  3  years  existence.  He  had  been  an  inmate  of  a  public 
institution  for  2H  years  before.  He  had  a  very  irregular  income.  His  parents  were 
living  in  Europe.  He  had  i  brother  in  this  country,  who  worked  for  small  wages. 
The  prognosis  was  unfavorable. 

Case  91.    A   native   of   Italy.     Age   19  years.    A   married   woman,   deserted  by  her 

husband  2  years  before  admission. 

This  patient  landed  at  New  York  in  1903.  The  diagnosis  was  chronic  endome- 
tritis, with  chronic  gonorrhea.  The  history  indicated  gonorrheal  contraction  of  4 
years  before.  She  had  worked  in  a  factory  and  earned  $5.00  a  week.  At  the  time 
of  admission  to  the  Hospital  she  had  no  savings.  Her  mother  and  a  married  sister 
lived  in  New  York  State.     The  prognosis  was  unfavorable. 


ALIENS  AND   NON-RESIDENTS  235 

Case  92.     A  native  of  Ireland.    Age  46  years.    A  married  man. 

This  patient  landed  at  New  York  in  1900.  The  diagnosis  was  chronic  pulmonary 
tuberculosis  and  old  ischiorectal  abscess,  with  chronic  discharging  sinus.  He  was 
transferred  in  an  unimproved  condition  to  a  chronic  hospital.  He  had  previously 
been  an  inmate  at  a  public  hospital  for  6  months.  He  had  been  out  of  work  since 
January,  1913.     His  parents  were  living  in  Ireland.     The  prognosis  was  unfavorable. 

Case  93.    A  native  of  Austria.     Age  47  years.    A  single  man. 

This  patient  landed  in  the  United  States  in  July,  1905.  He  came  to  New  York  3 
months  before  admission  to  the  Hospital.  The  diagnosis  was  chronic  pulmonary 
tuberculosis,  of  about  2  years  existence.  He  earned  $7.00  a  week,  but  had  no  savings, 
and  no  relatives  in  this  country.  He  was  transferred  to  a  tuberculosis  hospital.  His 
father  was  living  in  Austria.  He  had  expected  to  return  shortly.  The  prognosis 
was  unfavorable. 

Case  94.    A  native  of  Germany.    Age  50  years.     A  widower. 

This  patient  landed  at  Baltimore,  Md.,  in  April,  1910.  The  diagnosis  was  neuras- 
thenia and  gastritis.  He  had  no  savings  at  the  time  of  admission  to  the  Hospital. 
His  relatives  were  in  Europe.  He  said  that  he  was  going  back  to  Germany  in  the 
fall.  He  was,  upon  discharge,  referred  to  the  Department  of  Public  Charities  for 
institutional  care.     The  prognosis  was  favorable. 

Case  95.     A  native  of  Italy.     Age  34  years.     A  married  man. 

This  patient  landed  at  New  York  in  June,  1908.  The  diagnosis  was  chronic 
fibrinous  pleurisy,  with  effusion  of  2  months  existence.  He  had  been  out  of  work  for 
2  months  prior  to  admission  and  had  no  savings.  His  wife  earned  $4.00  a  week. 
Three  small  children  were  dependent  upon  them.    The .  prognosis   was  unfavorable. 

Case  96.    A  native  of  Russia.    Age  28  years.     A  single  man. 

This  patient  landed  at  Boston,  Mass.,  in  1907.  The  diagnosis  was  facial  erysipelas. 
He  had  previously  been  treated  at  hospitals  in  Boston  and  New  York  City.  He  had 
been  out  of  work  for  6  months  prior  to  admission  and  had  no  savings.  He  had  no 
relatives  in  this  country.     The  prognosis  was  favorable. 

Case  97.    A  native  of  Hungary.     Age  29  years.    A  married  man. 

This  patient  landed  at  New  York  in  December,  1906.  The  diagnosis  was  empyema, 
with  a  history  of  6  weeks  existence,  originating  from  attempted  suicide.  He  had  been 
out  of  work  for  weeks  at  the  time  of  admission  to  the  Hospital  and  had  no  savings. 
His  only  relative  in  this  country,  a  brother,  earned  $8.00  a  week.  His  parents  were 
living  in  Europe.     The  prognosis  was  unfavorable. 

Case  98.    A  native  of  Russia.    Age  47  years.    A  single  man. 

This  patient  landed  at  New  York  in  1902.  The  diagnosis  was  chronic  pulmonary 
tuberculosis  of  i^  years  existence.  He  had  previously  been  a  patient  in  a  municipal 
hospital.  He  was  an  unskilled  laborer  and  earned  $5.00  a  week.  He  had  no  savings 
and  no  relatives  in  this  country.     The  prognosis   was  unfavorable. 

Case  99.    A  native  of  Sweden.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  January  25,  1912,  and  went  to  Ohio.  He  came 
from  Chicago,  111.,  about  I  month  prior  to  admission  to  the  Hospital.  The  diagnosis 
was  chronic  gonorrhea,  with  a  history  of  3  months  existence.  He  had  been  out  of 
work  for  some  time  and  had  no  savings.  A  sister,  in  California,  was  the  only  relative 
in  this  country.    His  parents  were  living  in  Sweden.     The  prognosis  was  unfavorable. 

Case  100.    A  native  of  Hungary.    Age  38  years.    A  married  woman. 

This  patient  landed  at  New  York  in  February,  1901.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  a  history  of  8  years  existence.  She  had  previously 
been  in  Bellevue  for  10  days  and  had  been  in  a  tuberculosis  hospital  for  7  weeks. 
She  was  transferred  to  a  tuberculosis  hospital.  Her  husband  earned  $10.00  a  week 
and  was  unable  to  pay  for  her  medical  treatment.  In  view  of  this  patient's  long  stay 
in  this  country,  it  might  be  questioned  whether  it  would  be  humane  to  deport  her. 
The  prognosis  was  unfavorable. 

Case  ioi.    A  native  of  Ireland.    Age  46  years.    A  single  man. 

This  patient  landed  at  Philadelphia  in  1900.  He  came  to  this  city  from  Florida 
a  week  before  his  admission  to  the  Hospital.    The  diagnosis  was  chronic  pulmonary 


236  HOSPITAL   COMMITTEE 

tuberculosis,  with  a  history  of  12  months  existence.  He  had  been  out  of  work  2 
months,  and  had  no  relatives  in  this  country.  He  was  transferred  in  an  unimproved 
condition  to  a  tuberculosis  hospital.     The  prognosis  was  unfavorable. 

Case  102.    A  native  of,  Austria.    Age  23  years.    A  single  woman. 

This  patient  landed  at  New  York  in  February,  1908.  The  diagnosis  was  par- 
turition. At  the  time  of  admission  to  the  Hospital  she  had  no  savings.  Her  parents 
were  living  in  Austria  and  she  had  no  relatives  in  this  country.  The  medical  prog- 
nosis was  favorable. 

Case  103.    A  native  of  Italy.    Age  33  years.     A  single  man. 

This  patient  landed  at  New  York  in  1904.  The  diagnosis  was  inguinal  hernia, 
which  had  appeared  after  heavy  lifting  i  month  previous  to  admission  to  the  Hos- 
pital. He  was  discharged  in  an  unimproved  condition.  This  man  did  not  pay  for 
his  maintenance  at  the  Hospital.  The  only  relative  in  this  country  was  a  brother.  His 
mother  was  living  in  Italy.     The  prognosis  was  favorable. 

Case  104.    A  native  of  West  Indies.     Age  17  years.     A  single  man. 

This  patient  landed  at  New  York  in  August,  191 1.  The  diagnosis  was  syringo- 
myelia, with  a  history  of  illness  since  November,  1912.  This  patient  had  been  out 
of  work  S  months  and  had  no  savings.  The  only  relative  in  this  country  was  a 
brother.  His  parents  were  living  in  the  West  Indies  Islands.  The  prognosis  was 
unfavorable  and  indicated  a  progressive  condition. 

Case  105.    A  native  of  Austria.    Age  28  years.    A  single  woman. 

This  patient  landed  at  New  York  in  November,  1910.  The  diagnosis  was  par- 
turition. She  had  been  out  of  work  for  2  months  prior  to  admission  to  the  Hospital 
and  had  no  savings.  She  had  no  relatives  in  this  country.  The  medical  prognosis 
was  favorable. 

Case  106.    A  native  of  Russia.    Age  40  years.    A  married  man. 

This  patient  landed  at  New  York  in  December,  1908.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  a  history  of  3  years  existence.  He  had  been  out  of 
work  for  a  month  prior  to  admission  and  had  no  savings.  His  wife,  a  dressmaker, 
earned  about  $3.00  a  week.  They  had  i  dependent  child.  The  prognosis  was  un- 
favorable. 

Case  107.    A  native  of  Ireland.     Age  40  years.     A  single  man. 

This  patient  landed  at  New  York  in  March,  1897.  He  came  to  this  City  about 
2  months  prior  to  admission  to  the  Hospital,  from  Norwich,  Conn.,  where  he  had 
lived  for  16  years.  The  diagnosis  was  syphilis  of  lungs,  with  a  history  of  respiratory 
illness  for  3  months.  He  had  contracted  syphilis  3  years  before.  He  had  been  out 
of  work  and  could  not  pay  for  his  maintenance  at  the  Hospital.  He  had  been  living 
in  various  lodging  houses  and  had  previously  been  treated  at  a  New  York  City 
municipal  hospital.     The  prognosis  was  unfavorable. 

Case  108.    A  native  of  Russia.     Age  33  years.    A  single  man. 

This  patient  landed  at  New  York  October  3,  1904.  He  came  to  New  York  City 
about  2  months  prior  to  admission  to  the  Hospital,  from  Chicago,  111.,  where  he  had 
lived  21/2  years.  The  diagnosis  was  chronic  tuberculous  arthritis,  with  a  history  of 
S  years  existence.  He  had  previously  been  a  patient  in  a  public  hospital  in  Chicago, 
111.,  for  5  months.  He  had  been  out  of  work  3  months  and  had  no  savings  at  the 
time  of  admission  to  the  Hospital.  He  had  2  married  sisters  in  Chicago.  The  prog- 
nosis was  unfavorable. 

Case  109.    A  native  of  Austria.    Age  31  years.    A  married  man. 

This  patient  landed  at  New  York  in  April,  1913.  The  diagnosis  was  fracture  of 
pelvis  and  os  calcis.  After  10  days  stay  at  Bellevue  he  was  transferred  to  a  chronic 
hospital.  He  had  no  savings.  His  wife  and  4  dependent  children  were  living  in 
Austria.    The  prognosis  was  unfavorable. 

Case  iio.    A  native  of  Germany.    Age  29  years.     A  single  woman. 

This  patient  landed  at  New  York  October  3,  1910,  and  went  to  Missouri.  The 
diagnosis  vv'as  chronic  pulmonary  tuberculosis,  with  a  history  of  3  months  of  acute 
illness.  She  came  to  this  City  2  months  previous  to  admission  to  Bellevue  on  her 
way  back  to  Germany.     She  was  transferred  to  a  tuberculosis  hospital.     She  had  ex- 


ALIENS  AND   NON-RESIDENTS  237 

pended  all  her  savings  during  her  illness  in  New  York  City.     She  had  no  relatives 
in  this  country.     The  prognosis  vv^as  unfavorable. 

Case  hi.    A  native  of  Austria.    Age  20  years.    A  single  woman. 

This  patient  landed  at  New  York  in  March,  igio.  The  diagnosis  was  parturition. 
She  had  been  a  patient  at  Bellevue  a  month  before.  The  history  showed  that  she 
had  also  given  birth  to  a  child  2  years  before.  Her  father  lived  in  New  Jersey  and 
her  mother  in  Austria.     The  medical  prognosis  was  favorable. 

Case  112.    A  native  of  Ireland.    Age  25  years.    A  single  man. 

This  patient  landed  at  New  York  October  24,  1909,  and  went  to  Florida.  The 
diagnosis  was  chronic  pulmonary  tuberculosis  and  fistula  in  ano,  with  a  history  of  6 
months  of  acute  illness.  He  was  transferred  to  a  tuberculosis  hospital.  He  had  been 
out  of  work  for  a  month  prior  to  admission  to  the  Hospital  and  had  no  savings.  His 
only  relatives  in  this  country  were  2  married  sisters.  His  parents  were  living  in 
Ireland.    The  prognosis  was  unfavorable. 

Case  113.     A  native  of  Russia.    Age  50  years.    A  married  man. 

This  patient  landed  at  New  York  in  July,  1909.  The  diagnosis  was  chronic 
pulmonary  tuberculosis,  with  a  history  of  5  months  of  acute  illness.  He  was  trans- 
ferred to  a  tuberculosis  hospital  as  unimproved.  He  had  3  daughters,  working  in  a 
factory  and  earning  from  $5.00  to  $8.00  a  week  each.  His  wife  was  living  in  Europe. 
He  had  been  out  of  work  4  weeks  and  had  no  savings  at  the  time  of  admission  to 
the  Hospital.     The  prognosis  was  unfavorable. 

Case  114.    A  native  of  Russia.    Age  28  years.     A  married  man. 

This  patient  landed  at  New  York  in  January,  1909,  and  came  to  this  City  from 
Wisconsin  3  months  prior  to  admission  to  the  Hospital.  The  diagnosis  was  pulmonary 
tuberculosis,  with  a  history  of  6  weeks  of  acute  illness.  He  had  been  out  of  work 
for  6  weeks  prior  to  entering  the  Hospital  and  had  no  savings.  His  wife  was  unable 
to  help  him.  The  only  other  relative  in  this  country  was  a  brother,  who  earned  $16.00 
a  week.     His  parents  were  living  in  Russia.     The  prognosis  was  unfavorable. 

Case  115.    A  native  of  Hungary.    Age  33  years.    A  married  man. 

This  patient  landed  at  New  York  in  1902.  The  diagnosis  was  syphilis,  with  a 
history  of  ulcers  for  2  or  3  months.  He  had  been  out  of  work  6  weeks  and  had  no 
savings  at  the  time  of  admission  to  the  Hospital.  He  had  2  children  dependent  upon 
him.  His  wife  had  deserted  him  some  time  before.  He  had  no  other  relatives  in 
this  country.     His  parents  were  living  in  Hungary.     The  prognosis  was  unfavorable. 

Case  116.    A  native  of  Ireland.     Age  30  years.     A  single  man. 

This  patient  landed  at  New  York  in  June,  1907.  The  diagnosis  was  chronic  alco- 
holism, with  an  alcoholic  history  for  4  years.  He  was  an  unskilled  laborer  and  had 
been  unemployed  for  i  week  prior  to  admission  to  the  Hospital.  He  had  no  savings 
and  was  unable  to  pay  for  the  medical  treatment  at  the  hospital.  His  parents  were 
living  in  Ireland.  The  only  relative  in  this  country  was  a  sister.  The  prognosis  wa» 
unfavorable. 

Case  117.    A  native  of  Russia.     Age  36  years.     A  married  man. 

This  patient  landed  at  New  York  in  January,  1904.  The  diagnosis  was  pre-senile 
gangrene  of  the  foot,  with  a  history  of  5  years  contributing  condition.  He  had 
been  out  of  work  for  6  weeks  prior  to  admission  to  the  hospital.  His  wife  was 
dependent  upon  him.  He  had  no  other  relatives  in  this  country.  His  father  was 
living  in  Russia.    The  prognosis  was  unfavorable. 

Case  118.     A  native  of  Turkey.     Age  24  years.    A  single  man. 

This  patient  landed  at  New  York  in  1898.  He  came  to  New  York  from  New  Jer- 
sey for  treatment.  He  had  never  lived  in  New  York  City.  The  diagnosis  was 
tenosynovitis,  with  a  history  of  7  years  existence.  He  had  previously  been  a  patient 
at  Bellevue.  He  earned  $15.75  a  week,  but  had  no  savings.  His  parents  were  de- 
pendent upon  him.     The  prognosis  was  unfavorable. 

Case  119.     A  native  of  Ireland.    Age  40  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1898.  The  diagnosis  was  syphilis.  She  was 
transferred  to  a  chronic  hospital.  She  had  no  relatives  in  this  country.  The  prog- 
nosis was  unfavorable. 


238  HOSPITAL   COMMITTEE 

Case  120.     A  native  of  Russia.    Age  17  years.    A  single  woman. 

This  patient  landed  at  New  York  in  March,  1912.  The  diagnosis  was  parturition. 
She  had  been  a  patient  at  Bellevue  Hospital  6  months  before.  She  had  been  out 
of  work  3  months  and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  The 
only  relative  in  this  country  was  a  brother,  who  earned  $16.00  a  week.  The  medical 
prognosis  was  favorable. 

Case  121.    A  native  of  Russia.     Age  20  years.     A  single  man. 

This  patient  landed  at  New  York  in  1910.  The  diagnosis  was  valvular  cardiac 
disease,  with  history  of  acute  illness  for  i  week  before  admission.  His  relatives 
were  living  in  Russia.  He  had  been  out  of  work  at  the  time  of  admission  to  the 
Hospital  and  had  no  savings.     The  prognosis  was  unfavorable. 

Case  122.     A  native  of  Russia.    Age  23  years.    A  single  man. 

This  patient  landed  at  Baltimore  in  lOoS.  The  diagnosis  was  chronic  pulmonary 
tuberculosis,  with  a  history  of  acute  illness  for  i  year.  The  history  showed  that  his 
mother  died  of  tuberculosis.  He  earned  only  $6.00  a  week  and  had  been  out  of  work 
a  week  prior  to  the  admission  to  the  Hospital.  He  had  no  savings.  His  relatives 
were  all  in  Russia.    The  prognosis  was  unfavorable. 

Case  123.    A  native  of  Italy.    Age  18  years.     A  single  man. 

This  patient  landed  at  New  York  in  1904.  The  diagnosis  was  chronic  pulmonary 
tuberculosis,  with  a  history  of  2  years  existence.  He  had  been  unemployed  6  months 
and  had  no  savings  at  the  time  of  admission  to  the  Hospital.  His  father  was  living 
in  Italy.  His  brothers  and  a  sister  were  living  in  this  country.  The  prognosis  was 
unfavorable. 

Case  124.     A  native  of  Ireland.     Age  29  years.     A  single  man. 

This  patient  landed  at  New  York  in  October,  1902.  The  diagnosis  was  alco- 
holism, of  undetermined  extent.  He  had  been  in  Bellevue  Hospital  3  weeks  before. 
He  had  been  out  of  work  for  2  months  prior  to  entering  the  Hospital.  The  only 
relative  in  this  country  was  a  married  sister.    The  prognosis  was  unfavorable. 

Case  125.     A  native  of  Russia.     Age  40  years.     A  married  man. 

This  patient  landed  at  New  York  in  January,  1905.  The  diagnosis  was  gonorrheal 
polyarthritis,  following  infection  6  months  before.  He  earned  $20.00  a  week,  but 
had  been  unemployed  6  months  and  had  no  savings  at  the  time  of  admission  to  the 
Hospital.  He  was  transferred  to  a  chronic  hospital.  His  wife,  a  dressmaker,  earned 
about  $10.00  a  week  and  supported  3  children.  His  mother  was  living  in  Europe. 
The  prognosis  was  unfavorable. 

Case  126.     A  native  of  Austria.     Age  26  years.     A  single  man. 

This  patient  landed  at  New  York  in  August,  1904.  He  came  to  this  City  from 
San  Francisco,  where  he  had  lived  for  9  years,  about  2  months  prior  to  admission 
to  the  Hospital.  The  diagnosis  was  syphilis  and  gonorrheal  infection,  with  a  syphilitic 
history  for  3  years  and  gonorrheal  infection  4  months  before.  He  had  no  savings  at 
the  time  of  admission  to  the  Hospital  and  had  no  relatives  in  this  country.  The 
prognosis  was  unfavorable. 

Case  127.    A  native  of  Greece.    Age  23  years.    A  single  man. 

This  patient  landed  at  New  York  in  March,  1911,  and  went  to  Pennsylvania.  He 
came  to  this  City  from  Pennsylvania,  where  he  had  lived  for  2  years  and  3  months 
prior  to  admission  to  the  Hospital.  The  diagnosis  was  chronic  pulmonary  tuberculosis, 
with  a  history  of  8  months  existence.  He  was  transferred  to  a  chronic  hospital.  He 
had  no  relatives  in  this  country  and  no  savings  at  the  time  of  admission  to  the 
Hospital.     The  prognosis  was  unfavorable. 

Case  128.    A  native  of  Italy.    Age  32  years.     A  widower. 

This  patient  landed  at  New  York  in  April,  1910,  and  went  to  Philadelphia.  He 
came  from  Philadelphia  to  this  City  about  2  months  prior  to  admission  to  the  Hos- 
pital. The  diagnosis  was  chronic  pulmonary  tuberculosis,  with  a  history  of  5  months 
of  acute  illness.  He  earned  $15.00  a  week,  but  at  the  time  of  admission  to  the 
Hospital  he  had  no  savings.  He  had  no  relatives  in  this  country  and  had  2  children 
dependent  upon  him  in  Italy. 


ALIENS  AND   NON-RESIDENTS  239 

Case  129.    A  native  of  Austria.    Age  22  years.    A  single  wornan. 

This  patient  landed  at  New  York  in  October,  1907.  The  diagnosis  was  parturition. 
She  had  no  relatives  in  this  country.  Her  parents  were  living  in  Austria.  At  the 
time  of  admission  to  the  Hospital  she  had  no  savings.  The  medical  prognosis  was 
favorable. 

Case  130.    A  native  of  Ireland.    Age  37  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1898.  The  diagnosis  was  chronic  alcoholism, 
with  an  alcoholic  history  of  undetermined  extent.  She  had  been  out  of  work  for 
I  month  prior  to  admission  to  the  Hospital.  She  had  no  relatives  in  this  country. 
The  prognosis  was  unfavorable. 

Case  131.    A  native  of  Russia.    Age  29  years.    A  married  woman. 

This  patient  landed  at  New  York  in  May,  1905.  The  diagnosis  was  chronic  pul- 
monary tuberculosis,  with  a  history  of  2>4  years  illness.  She  had  previously  been 
admitted  to  Bellevue.  She  had  2  children  under  the  age  of  5  years.  Her  husband, 
a  rag  dealer,  did  not  pay  for  the  medical  treatment.    The  prognosis  was  unfavorable. 

Case  132.    A  native  of  Hungary.    Age  34  years.    A  married  man. 

This  patient  landed  at  New  York  in  May,  1903.  The  diagnosis  was  chronic 
gonorrhea,  contracted  in  January,  1912.  He  had  earned  $12.00  a  week,  but  had  been 
out  of  work  I  week  and  had  no  savings  at  the  time  of  admission  to  the  Hospital. 
He  did  not  know  the  whereabouts  of  his  wife,  and  had  no  other  relatives  in  this 
country.     The  prognosis  was  unfavorable. 

Case  133.    A  native  of  England.    Age  26  years.    A  single  man. 

This  patient  was  a  seaman.  The  diagnosis  was  venereal  trouble,  with  a  history 
of  infection  of  2  years  before.  He  was  brought  by  an  ambulance  directly  from  the 
ship  to  the  Hospital.  He  had  no  savings  and  the  steamship  company  failed  to  pay 
for  him.  He  had  no  relatives  in  this  country.  His  mother  was  living  in  England. 
The  prognosis  was  unfavorable. 


CLASS  I-4a.    Aliens  deportable    {with   consent)    under   the  State  Insanity  Law. — 
From  causes  existing  prior  to  landing. 

Case  i.    A  native  of  Italy.    Age  36  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1909.  She  was  in  the  Hospital  for  psycho- 
pathic examination  and  was  transferred  as  insane  to  a  State  Hospital.  The  diagnosis 
was  general  paresis,  with  causes  existing  prior  to  landing.  The  prognosis  was  un- 
favorable. 

Case  2.    A  native  of  Russia.    Age  34  years.    A  single  man. 

This  patient  landed  at  New  York  in  1908.  He  was  in  the  Hospital  for  psycho- 
pathic observation,  with  condition  originating  prior  to  landing  in  the  United  States. 
He  was  transferred  as  insane  to  a  State  hospital.     The  prognosis  was  unfavorable. 

Case  3.    A  native  of  Italy.    Age  30  years.    A  married  woman. 

This  patient  landed  at  New  York  in  1908.  She  was  suffering  from  general 
paresis,  with  condition  originating  prior  to  landing  in  the  United  States.  She  was 
transferred  as  insane  to  a  State  hospital.     The  prognosis  was  unfavorable. 

Case  4.    A  native  of  Russia.     Age  30  years.    A  single  man. 

This  patient  landed  at  New  York  in  1908.  This  was  a  psychopathic  case  de- 
ported twice  previously,  and  deported  the  third  time  after  this  admission  when  trans- 
ferred as  insane  to  a  State  hospital. 

Case  5.    A  native  of  Germany.    Age  42  years.    A  married  woman. 

This  patient  landed  at  New  York  in  1908.  She  was  a  psychopathic  patient  with 
condition  originating  priorto  landing  and  also  suffering  from  pulmonary  tuberculosis. 
She  was  an  attempted  suicide.  She  was  transferred  as  insane  to  a  State  hospital. 
The  prognosis  was  unfavorable. 


240  HOSPITAL   COMMITTEE 

Case  6.     A  native  of  Russia.     Age  20  years.    A  single  woman. 

This  patient  landed  at  New  York  in  December,  1909.  She  was  a  psychopathic 
patient,  with  condition  originating  prior  to  landing  in  this  country.  The  prognosis 
was  unfavorable. 

Case  7.    A  native  of  Russia.    Age  60  years.     A  widow. 

This  patient  landed  at  New  York  in  1908.  She  was  admitted  to  the  psychopathic 
ward  for  observation.  The  diagnosis  was  senile  dementia,  with  history  of  unbal- 
anced mentality  for  a  period  of  5  years  or  more  prior  to  landing.  She  was  trans- 
ferred as  insane  to  a  State  hospital.     The  prognosis  was  unfavorable. 

Case  8.    A  native  of  Austria.    Age  35  years.    A  married  man. 

This  patient  landed  at  New  York  in  1908.  He  was  admitted  for  psychopathic 
observation.  The  diagnosis  was  dementia  precox.  The  medical  history  recorded  a 
statement  that  the  patient  had  been  insane  for  a  period  of  3>4  years.  One  of  his 
sisters  was  an  inmate  of  a  State  hospital  for  insane  and  2  of  his  cousins  had  com- 
mitted suicide.  He  was  returned  to  Austria  at  the  expense  of  his  relatives.  The 
prognosis  was  unfavorable. 

Case  9.     A  native  of  Russia.    Age  20  years.     A  single  man. 

This  patient  landed  at  New  York  in  1905.  He  was  admitted  as  a  psychopathic 
patient,  with  condition  originating  prior  to  landing.  He  was  transferred  as  insane 
to  a  State  hospital.     The  prognosis  was  unfavorable. 

Case  id.    A  native  of  Russia.    Age  21  years.    A  single  man. 

This  patient  landed  at  New  York  in  1902  and  ever  since  had  lived  in  Chicago. 
He  was  brought  from  the  Grand  Central  Depot  to  the  Hospital  as  a  psychopathic 
patient,  with  condition  originating  prior  to  landing.  He  was  transferred  as  insane  to 
a  State  hospital  and  afterward  removed  at  the  expense  of  the  State  to  Chicago. 
The  prognosis  was  unfavorable. 

Case  ii.    A  native  of  Italy.    Age  18  years.    A  single  man. 

This  patient  landed  at  New  York  in  1908.  He  had  been  an  imbecile  prior  to 
landing.     He  was  deported  to  Italy  by  his  relatives  through  the  State. 

Case  12.    A  native  of  Ireland.     Age  24  years.     A  married  woman. 

This  patient  landed  at  New  York  in  1908.  She  was  admitted  to  the  Hospital  as  a 
psychopathic  patient,  from  causes  originating  prior  to  landing.  She  was  transferred 
as  insane  to  a  State  hospital  and  then  deported  by  the  State. 

Case  13.    A  native  of   Hungary.     Age  14  years.     A   girl. 

This  patient  landed  at  New  York  in  1908.  She  was  admitted  to  the  psychopathic 
ward  for  observation.  The  history  showed  that  her  condition  originated  prior  to 
landing.  She  was  transferred  as  insane  to  a  State  hospital.  The  prognosis  was 
unfavorable. 

Case  i^.    A  native  of  Russia.     Age  26  years.     A  married  woman. 

This  patient  landed  at  New  York  in  igo8.  She  came  from  Chicago  and  was 
taken  from  the  Grand  Central  Depot,  on  the  same  day,  to  the  Hospital  for  psycho- 
pathic observation.  The  history  showed  that  her  condition  originated  prior  to  land- 
ing. She  was  to  have  been  deported  4  months  previously,  but  escaped.  She  was  de- 
ported to  her  home  abroad  by  friends. 

Case  15.    A  native  of  Italy.    Age  17  years.    A  single  man. 

This  patient  landed  at  New  York  in  1908.  He  was  admitted  for  psychopathic 
observation.  The  diagnosis  was  dementia  prrecox,  from  causes  originating  prior  to 
landing.  He  was  transferred  as  insane  to  a  State  hospital.  The  prognosis  was  un- 
favorable. 

Case  16.     A  native  of  Russia.     Age  23  years.    A  single  man. 

This  patient  landed  at  New  York  in  August,  igo8.  He  had  been  a  resident  of 
Jersey  City  since  landing  and  was  admitted  to  the  Hospital  for  psychopathic  observa- 
tion. The  diagnosis  was  dementia  pra:cox,  from  causes  e.Nisting  prior  to  landing. 
The  history  contained  a  record  of  two  attempts  to  commit  suicide.  He  was  trans- 
ferred as  insane  to  a  State  hospital.     The  prognosis  was  unfavorable. 


ALIENS  AND   NON-RESIDENTS  241 

Case  17.    A  native  of  Mexico.     Age  38  years.     A  single  man. 

This  patient  came  to  the  United  States  via  the  Mexican  border.  He  had  been 
an  inmate  of  an  insane  hospital  at  Washington,  D.  C,  for  the  previous_6  months  and 
had  been  taken  from  there  by  his  brother,  who  intended  to  remove  him  to  Mexico. 
The  patient,  however,  refused  to  go.  His  brother  said  that  he  had  been  mentally 
irresponsible  for  12  years.  He  was  returned  to  Mexico  by  representatives  in  this 
country. 

Case  18.    A  native  of  Russia.    Age  38  years.    A  single  man. 

This  patient  landed  at  New  York  in  1905.  He  had  been  only  3  days  in  this 
State.  He  had  come  from  Massachusetts.  He  had  been  admitted  for  psychopathic 
observation  and  was  transferred  as  insane  to  a  State  hospital.  The  history  showed 
that  his  condition  originated  prior  to  landing.     The  prognosis  was  unfavorable. 

C.^SE  19.     A  native  of  Russia.     Age  27  years.     A  single  man. 

This  patient  landed  at  New  York  in  igo8.  He  was  admitted  to  the  Hospital 
for  psychopathic  observation  and  transferred  as  insane  to  a  State  hospital.  His 
history  showed  that  his  condition  originated  prior  to  landing.  The  prognosis  was 
unfavorable. 

Case  20.    A  native  of  Italy.    Age  28  years.     A  single  man. 

This  patient  landed  at  New  York  in  igii.  He  had  been  admitted  to  the  psycho- 
pathic ward  for  observation.  His  history  showed  that  his  father  had  been  insane. 
His  condition  was  from  causes  existing  prior  to  landing.  He  was  transferred  as  in- 
sane to  a  State  hospital.  He  had  returned  to  Italy  2  years  ago  and  came  back  to 
this  country  3  months  before  admission  to  the  Hospital  with  symptoms  of  this 
trouble.    The  prognosis  was  unfavorable. 

Case  21.    A  native  of  Turkey.    Age  28  years.     A  single  man. 

This  patient  landed  at  New  York  in  igo8.  He  came  to  New  York  from  Montana 
the  day  before  admission  to  the  Hospital.  An  eflort  had  previously  been  made  to 
deport  him  from  California,  but  the  steamship  company  had  refused  to  accept  him. 
The  history  showed  that  his  condition  originated  prior  to  landing  and  existed  prior 
to  coming  to  this  State.  He  was  transferred  as  insane  to  a  State  hospital.  The 
prognosis  was  unfavorable. 

Case  22.     A  native  of  Russia.    Age  30  years.     A  married  woman. 

This  patient  landed  at  New  York  in  1907.  She  was  admitted  to  the  Hospital  for 
psychopathic  observation.  The  history  showed  that  her  condition  had  originated 
prior  to  landing.  She  was  transferred  as  insane  to  a  State  hospital.  The  prognosis 
was  unfavorable. 

Case  23.     A  native  of  Ireland.     Age  27  years.    A  single  man. 

This  patient  landed  at  New  York  in  igo8.  He  had  been  a  chronic  alcoholic  and 
was  admitted  to  the  psychopathic  ward  for  observation.  The  diagnosis  was  dementia 
prsscox.  His  father  had  been  insane.  His  condition  was  due  to  inherited  tendency 
and  constitutionally  inferior  mentality,  consequently  originating  prior  to  landing.  He 
was  discharged  in  the  custody  of  the  Tombs  officials.    The  prognosis  was  unfavorable. 

Case  24.     A  native  of  Russia.    Age  50  years.     A  married  man. 

This  patient  landed  at  New  York  in  1908.  He  had  been  admitted  to  the  Hospital 
for  psychopathic  observation.  His  condition  originated  prior  to  landing.  He  was 
transferred  as  insane  to  a  State  hospital.    The  prognosis  was  unfavorable. 

Case  25.    A  native  of  Germany.    Age  48  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1881.  She  was  admitted  to  the  Hospital  for 
psychopathic  observation.  The  history  showed  that  her  condition  was  constitutional 
and  originated  prior  to  landing.  She  was  transferred  as  insane  to  a  State  hospital. 
The  prognosis  was  unfavorable. 

Case  26.     A  native  of  Hungary.    Age  33  years.     A  single  man. 

This  patient  landed  at  New  York  November  4,  1907.  He  had  come  to  New  York 
from  Ohio  3  weeks  before  admission  to  the  Hospital  for  psychopathic  observation. 
His  history  showed  that  he  had  been  a  chronic  alcoholic  and  that  his  mental  con- 
dition had  originated  prior  to  landing.  He  was  discharged  in  the  custody  of  the 
State  officials. 


242  HOSPITAL   COMMITTEE 

Case  27.    A  native  of  Russia.    Age  54  years.    A  widow. 

This  patient  landed  at  New  York  in  1908.  She  had  been  admitted  to  the  Hospital 
for  psychopathic  observation.  The  history  showed  that  her  condition  had  originated 
prior  to  landing.  She  was  transferred  as  insane  to  a  State  hospital.  The  prognosis 
was  unfavorable. 

Case  28.    A  native  of  Russia.    Age  72  years.    A  widow. 

This  patient  landed  at  New  York  in  1906.  She  had  been  an  inmate  of  a  charitable 
institution  ever  since  landing.  She  was  admitted  to  the  psychopathic  ward  for 
observation.  Her  history  showed  that  the  condition  existed  prior  to  landing.  She 
was  transferred  as  insane  to  a  State  hospital.  The  prognosis  was  unfavorable. 

Case  29.    A  native  of  Turkey.    Age  42  years.    A  married  man. 

This  patient  landed  at  New  York  in  1909.  He  had  secondary  syphilis,  with  a 
history  of  luetic  infection  of  years'  standing.  His  condition  originated  prior  to  land- 
ing.   The  prognosis  was  unfavorable. 

Case  30.    A  native  of  France.     Age  33  years.     A  single  woman. 

This  patient  landed  at  New  York  in  1909.  She  had  been  admitted  to  the  Hos- 
pital for  psychopathic  observation.  Her  history  showed  that  the  condition  had 
originated  prior  to  landing.  The  patient's  mother  had  been  insane.  She,  herself,  had 
showed  evidence  of  insanity  for  years.  She  was  transferred  as  insane  to  a  State 
hospital.     The  prognosis   was  unfavorable. 

Case  31.     A  native  of  Greece.    Age  27  years.    A  single  man. 

This  patient  landed  at  New  York  January  4,  1907.  He  was  admitted  to  the 
Hospital  for  psychopathic  observation.  His  history  showed  that  his  condition  had 
originated  prior  to  landing.  He  was  transferred  as  insane  to  a  State  hospital.  The 
prognosis  was  unfavorable. 

Case  32.    A  native  of  Austria.    Age  46  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1905.  She  was  admitted  to  the  Hospital 
for  psychopathic  observation.  Her  history  showed  that  the  condition  had  originated 
prior  to  landing.  She  was  transferred  as  insane  to  a  State  hospital.  The  prognosis 
was  unfavorable. 

Case  33.    A  native  of  Russia.    Age  16  years.    A  girl. 

This  patient  landed  at  New  York  in  1908.  She  was  admitted  to  the  psychopathic 
ward  for  observation.  The  history  showed  that  her  condition  had  originated  prior 
to  landing.  Her  maternal  aunt  had  been  insane.  She  was  transferred  as  insane  to  a 
State  hospital.     The  prognosis  was  unfavorable. 

Case  34.    A  native  of  Russia.     Age  40  years.     A  married  man. 

This  patient  landed  at  New  York  in  1908.  The  history  showed  that  he  had  been 
an  alcoholic  and  that  his  condition  had  originated  prior  to  landing.  He  was  admitted 
to  the  psychopathic  ward  for  observation.  He  was  transferred  as  insane  to  a  State 
hospital.     The  prognosis  was  unfavorable. 

Case  35.    A  native  of  Hungary.    Age  26  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1902.  She  was  admitted  to  the  Hospital 
for  psychopathic  observation.  The  history  showed  that  her  condition  had  originated 
prior  to  landing.  She  was  removed  from  the  Hospital  by  her  relatives.  The  prog- 
nosis was  unfavorable. 

Case  36.    A  native  of  Hungary.    Age  24  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1909.  The  history  showed  that  her  con- 
dition had  originated  prior  to  landing.  She  was  transferred  as  insane  to  a  State 
hospital.     The  prognosis  was  unfavorable. 

Case  37.     A  native  of  Italy.     Age  23  years.    A  single  man. 

This  patient  landed  at  New  York  in  1905.  He  was  admitted  to  the  Hospital 
for  psychopathic  observation.  The  history  showed  that  his  condition  had  originated 
prior  to  landing.  He  was  transferred  as  insane  to  a  State  hospital.  The  prognosis 
was  unfavorable. 


ALIENS  AND   NON-RESIDENTS  243 

Case  38.    A  native  of  Ireland.    Age  27  years.    A  single  man. 

This  patient  landed  at  New  York  in  1908.  This  was  the  patient's  second  admis- 
sion to  the  psychopathic  ward  at  Bellevue.  The  diagnosis  was  dementia  prxcox. 
His  history  also  recorded  chronic  alcoholism.  He  was  transferred  to  a  State  hos- 
pital and  deported  at  State  expense. 

Case  39.    A  native  of  Russia.    Age  40  years.    A  man. 

This  patient  landed  at  New  York  in  1908.  The  history  showed  that  his  con- 
dition had  originated  prior  to  landing.  He  was  transferred  as  insane  to  a  State 
hospital.     The  prognosis  was  unfavorable. 

Case  40.    A  native  of  Russia.    Age  35  years.    A  single  man. 

This  patient  landed  at  New  York  April  11,  1910.  He  was  placed  on  a  train 
for  New  York  City  by  the  police  of  a  town  in  Massachusetts  and  was  brought  from 
Grand  Central  Depot  to  the  psychopathic  ward.  The  history  showed  that  his  con- 
dition had  originated  prior  to  landing.  He  was  transferred  as  insane  to  a  State 
hospital.     The  prognosis  was  unfavorable. 

Case  41.    A  native  of  Ireland.    Age  30  years.    A  single  woman. 

This  patient  landed  at  New  York  in  October,  1903.  She  was  admitted  to  the 
alcoholic  ward  and  transferred  to  the  psychopathic  ward  for  observation.  The  diag- 
nosis was  chronic  alcoholism  and  dementia.  The  history  showed  that  she  was  of  a 
constitutionally  inferior  make-up  and  that  her  condition  had  originated  prior  to 
landing.  She  was  transferred  as  insane  to  a  State  hospital.  The  prognosis  was 
unfavorable. 

Case  42.    A  native  of  Canada.    Age  52  years.    A  married  man. 

This  patient  landed  at  New  York  in  1906.  He  had  been  an  inmate  of  an  insane 
asylum  in  1902.  The  diagnosis  was  dementia  precox  (paranoid),  which  existed 
prior  to  landing.  This  patient  was  discharged  as  insane.  The  prognosis  was  un- 
favorable. 

Case  43.    A  native  of  Italy.    Age  41  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1909.  She  had  been  admitted  to  the  Hos- 
pital for  psychopathic  observation.  The  history  showed  that  her  condition  had  origi- 
nated prior  to  landing.     She  was  discharged  in  her  own  custody. 

Case  44.    A  native  of  Italy.    Age  36  years.    A  married  woman. 

This  patient  landed  in  the  United  States  in  1908.  She  had  been  admitted  to  the 
Hospital  for  psychopathic  observation.  The  history  showed  that  her  condition  had 
originated  prior  to  landing.  She  was  transferred  as  insane  to  a  State  hospital.  The 
prognosis  was  unfavorable. 

Case  45.    A  native  of  Russia.    Age  18  years.    A  single  woman. 

This  patient  landed  at  New  York  in  1905.  She  had  been  admitted  to  the  Hos- 
pital for  psychopathic  observation.  The  diagnosis  was  dementia  prscox,  which  had 
originated  prior  to  landing.  She  was  transferred  as  insane  to  a  State  hospital.  The 
prognosis  was  unfavorable. 

Case  46.    A  native  of  France.    Age  50  years.    A  widow. 

This  patient  landed  at  New  York  in  1907.  She  had  been  admitted  to  the  Hos- 
pital for  psychopathic  observation.  The  history  showed  that  her  condition  had  origi- 
nated prior  to  landing.  She  was  transferred  as  insane  to  a  State  hospital.  The 
prognosis  was  unfavorable. 

Case  47.     A  native  of  British  West  Indies.    Age  24  years.    A  widow. 

This  patient  landed  at  New  York  in  1904.  She  came  to  this  State  in  April, 
1913.  She  had  been  admitted  to  the  Hospital  for  psychopathic  observation.  The 
diagnosis  was  dementia  pracox  (paranoid),  which  originated  prior  to  landing.  She 
was  transferred  as  insane  to  a  State  hospital.     The  prognosis  was  unfavorable. 

Case  48.    A  native  of  Germany.    Age  33  years.    A  single  man. 

This  patient  landed  at  New  York  in  1907.  The  history  showed  that  his  condition 
originated  prior  to  landing.  He  was  transferred  as  insane  to  a  State  hospital.  The 
prognosis  was  unfavorable. 


244 


HOSPITAL   COMMITTEE 


Case  49.    A  native  of  Italy.    Age  22  years.    A  married  woman. 

This  patient  landed  at  New  York  December  14,  1909.  She  had  been  admitted 
to  the  Hospital  for  psychopathic  observation.  The  history  showed  that  her  con- 
dition had  originated  prior  to  landing  and  that  she  had  always  been  peculiar  in  her 
behavior.  She  had  practically  deserted  her  husband  and  3  small  children.  She  was 
transferred  as  insane  to  a  State  hospital.  The  prognosis  was  unfavorable. 

Case  50.    A  native  of  Russia.     Age  27  years.     A  single  man. 

This  patient  landed  at  New  York  in  1907.  He  had  been  admitted  to  the  Hospital 
for  psychopathic  observation.  The  history  showed  that  his  condition  had  originated 
prior  to  landing  and  that  he  had  an  advanced  form  of  syphilis.  He  was  transferred 
as  insane  to  a  State  hospital.     The  prognosis  was  unfavorable. 

Case  51.    A  native  of  Austria.    Age  25  years.    A  married  woman. 

This  patient  landed  at  New  York  in  May,  1903.  She  had  been  admitted  to  the 
Hospital  for  psychopathic  observation.  The  diagnosis  was  dementia  prxcox  (para- 
noid), which  had  originated  prior  to  landing.  She  was  transferred  as  insane  to  a 
State  hospital.     The  prognosis  was  unfavorable. 

Case  52.    A  native  of  Austria.    Age  32  years.     A  married  man. 

This  patient  landed  the  second  time  on  ]March  24,  1910.  He  had  been  deported 
by  the  Federal  authorities  in  January,  1910.  He  had  been  admitted  to  the  Hospital 
for  psychopathic  observation.  The  history  showed  that  his  condition  had  originated 
prior  to  landing.  He  was  transferred  as  insane  to  a  State  hospital.  The  prognosis 
was  unfavorable. 

CLASS  I-4b.    Aliens  deportable    {with   consent)    under  the  State  Insanity   Law. — 
From  causes  whose  priority  to  landing  is  not  certain. 

Case  i.    A  native  of  Austria.     Age  22  years.    A  single  man. 

This  patient  landed  at  New  York  in  1907.  He  had  been  a  chronic  alcoholic  and 
had  been  admitted  to  the  Hospital, for  psychopathic  observation.  It  was  not  estab- 
lished whether  or  not  he  had  psychopathic  conditions  existing  prior  to  landing.  The 
prognosis  was  unfavorable. 

Case  2.     A  native  of  Italy.    Age  42  years.    A  single  man. 

This  patient  landed  at  New  York  in  1905.  He  was  admitted  to  the  psychopatliic 
ward  for  observation.  The  diagnosis  was  general  paresis,  with  evidence  of  syphilis. 
His  condition  was  probably  due  to  causes  existing  prior  to  landing.  He  was  trans- 
ferred as  insane  to  a  State  hospital.     The  prognosis  was  unfavorable. 

Case  3.    A  native  of  Hungary.    Age  36  years.    A  married  man. 

This  patient  landed  in  the  United  States  in  1909.  He  was  admitted  to  the  Hos- 
pital for  psychopathic  observation  and  was  transferred  as  insane  to  a  State  hospital. 
The  history  also  portrayed  alcoholism,  but  it  was  not  established  whether  his  mental 
condition  originated  prior  to  landing.     The  prognosis  was  unfavorable. 

Case  4.    A  native  of  Hungary.     Age  44  years.    A  married  man. 

This  patient  landed  in  the  United  States  in  1903.  He  was  admitted  to  the  Hos- 
pital for  psychopathic  observation  and  was  transferred  as  insane  to  a  State  hospital. 
The  history  showed  that  he  was  an  alcoholic,  but  it  was  not  established  whether  his 
mental  condition  had  originated  prior  to  landing.     The  prognosis   was  unfavorable. 

Case  5.    A  native  of  Austria.    Age  43  years.    A  widower. 

This  patient  landed  at  New  York  in  1910.  He  was  brought  from  a  private  hos- 
pital to  the  psychopathic  ward  for  observation.  The  history  showed  that  he  had  had 
an  injury  to  his  head  6  months  prior  to  admission.  It  could  not  be  determined 
whether  any  contributing  factors  to  his  mental  condition  had  existed  prior  to  landing. 
The  prognosis  was  unfavorable. 

Case  6.    A  native  of  Ireland.    Age  39  years.    A  single  woman. 

This  patient  landed  in  the  United  States  in  1904  She  was  admitted  to  the 
Hospital  for  psychopathic  observation  and  was  transferred  as  insane  to  a  State  hos- 
pital. Her  condition  had  probably  originated  prior  to  landing.  The  prognosis  was 
unfavorable. 


ALIENS  AND   NON-RESIDENTS  245 

Case  7.     A  native  of  Italy.     Age  34  years.    A  widow. 

This  patient  landed  at  New  York  in  1907.  She  had  previously  been  admitted  to 
Bellevue  Hospital  for  psychopathic  observation.  She  had  a  3  years  history  of 
delusion.  It  was  not  determined  whether  her  mental  condition  had  originated  prior 
to  landing.  She  was  transferred  as  insane  to  a  State  hospital.  The  prognosis  was 
unfavorable. 

Case  8.     A  native  of  Russia.     Age  25  years.    A  married  man. 

This  patient  landed  at  New  York  in  1908.  He  had  been  admitted  to  the  psycho- 
pathic ward  for  observation.  It  was  not  determined  whether  his  mental  condition 
had  originated  prior  to  landing.  He  was  transferred  as  insane  to  a  State  hospital. 
The  prognosis  was  unfavorable. 

Case  9.     A  native  of  Austria.    Age  24  years.     A  married  man. 

This  patient  landed  at  New  York  in  1905.  He  was  admitted  to  the  psychopathic 
ward  for  observation.  He  had  been  a  chronic  alcoholic  for  years.  His  history 
.indicated  that  his  condition  probably  had  originated  prior  to  landing.  He  was  trans- 
ferred as  insane  to  a  State  hospital.     The  prognosis  was  unfavorable. 

Case  10.    A  native  of  Russia.     Age  23  years.    A  single  woman. 

This  patient  landed  at  New  York  in  igo8.  She  had  been  admitted  to  the  psycho- 
pathic ward  for  observation.  It  could  not  be  determined  whether  or  not  her  mental 
condition  had  originated  prior  to  landing.  She  was  discharged  in  the  custody  of  her 
mother.     The  prognosis  was  unfavorable. 

CLASS  I-4C.    Aliens   deportable    {with   consent)    under   the  State   Insanity   Law. — 
From  causes  existing  subsequent  to  landing. 

Case  i.    A  native  of  Russia.    Age  29  years.     A  married  woman,  who  was  separated 
from  her  husband  and  had  become  a  prostitute. 
This  patient  landed  at  New  York  in  1907.     She  came  to  this  State  2  days  before 
admission  to  the  Hospital.     Her  diagnosis  could  not  be   determined.     She  was   re- 
moved to  Connecticut  by  the  State. 

Case  2.    A  native  of  Russia.    Age  60  years.    A  widow. 

This  patient  landed  at  New  York  in  1907.  She  had  previously  been  admitted  to 
Bellevue  psychopathic  ward.  She  was  transferred  as  insane  to  a  State  hospital. 
The  prognosis  was  unfavorable. 

Case  3.    A  native  of  Switzerland.     Age  65  years.     A  married  man. 

This  patient  landed  at  New  York  47  years  ago.  He  had  been  settled  in  New 
Jersey  and  was  brought  from  there  on  the  day  of  admission  to  the  Hospital.  The 
diagnosis  was  senile  psychosis,  which  had  originated  prior  to  his  coming  to  New 
York  State.  He  was  transferred  as  insane  to  a  State  hospital.  The  prognosis  was 
unfavorable. 

Case  4.    A  native  of  Austria.    Age  39  years.     A  married  man. 

This  patient  landed  at  New  York  in  1901.  He  was  a  chronic  alcoholic,  with  a 
history  of  injury  to  the  head  i  year  previous  to  admission.  He  was  admitted  to  the 
psychopathic  ward  for  observation.  He  was  discharged  in  the  custody  of  his  wife. 
The  prognosis  was  unfavorable. 

Case  5.    A  native  of  Russia.     Age  29  years.    A  single  man. 

This  patient  landed  in  the  United  States  in  February,  1901.  He  had  resided  con- 
tinuously in  Chicago,  111.  He  was  taken  to  the  psychopathic  ward  directly  from 
the  Grand  Central  Depot.  The  diagnosis  was  general  paresis,  which  had  existed 
prior  to  coming  to  New  York  State.  This  patient  was  transferred  as  insane  to  a  State 
hospital.     The  prognosis  was  unfavorable. 


ADMISSIONS   TO  CITY   HOMES 
(ALMSHOUSES) 


THE  INVESTIGATION 

BY 
H.    B.    DiNWIDDIE 

SYNOPSIS 

When  the  Counties  of  New  York,  Kings,  Queens,  and  Richmond  were 
merged  into  the  City  of  New  York  the  problem  of  municipal  care  for 
the  dependent  poor  of  the  new  City  was  placed  under  the  administration 
of  one  department,  the  Department  of  Public  Charities,  which  replaced 
the  independent  local  authorities.  Not  only  was  the  local  administration 
of  the  public  charitable  relief  thus  affected,  but,  at  a  later  period,  some  re- 
distribution of  the  inmates  of  the  County  almshouses  took  place.  When 
the  Richmond  County  Almshouse,  with  the  farm  surrounding  it,  was  set 
aside  as  a  farm  colony  for  the  employment  of  the  more  able-bodied  depend- 
ents in  the  almshouses  of  the  City,  the  decrepit  and  mentally  enfeebled 
inmates  of  this  institution  were  transferred  to  other  institutions  more  appro- 
priate for  their  care.  A  steady  stream  of  transferred  dependents  began 
to  pour  into  this  colony  from  the  two  other  almshouses  and  grew  to  such 
proportions  that  the  local  function  of  this  almshouse  became  obscured. 

Not  only  were  the  three  almshouses  operated  by  one  fund,  appropriated 
by  the  Board  of  Estimate  and  Apportionment,  and  expended  under  the 
supervision  of  one  administrative  head,  the  Commissioner  of  Public  Chari- 
ties, but  they  became  also  interdependent  to  a  considerable  extent  in  provid- 
ing accommodation  for  the  dependent  poor  of  the  City. 

For  the  examination  of  applicants  for  admissions  to  the  alm.shouses  there 
were  established  Bureaus  of  Dependent  Adults  as  follows :  one  in  the  Bor- 
ough of  Manhattan  for  applicants  from  Manhattan  and  The  Bronx;  one  in 
the  Borough  of  Brooklyn  for  applicants  from  Brooklyn  and  Queens;  and 
one  in  the  Borough  of  Richmond  for  that  borough.  At  these  Bureaus  the 
applicants  that  were  not  properly  charges  upon  the  City  of  New  York  were 
supposed  to  be  sifted  out. 

A  study  was  made  of  the  admissions  to  the  three  almshouses  in  the  City 
of  New  York,  namely :  the  New  York  City  Home  for  the  Aged  and  In- 
firm, Manhattan  Division ;  the  New  York  City  Home  for  the  Aged  and  In- 
firm, Brooklyn  Division;  and  New  York  City  Farm  Colony.  This  study 
included  a  general  examination  of  the  admissions  to  the  three  almshouses 
during  the  year  191 1  and  the  first  6  months  of  the  year  1912,  with  a  de- 
tailed study  of  the  admissions  in  2  months  of  these  years.  It  developed 
that,  while  the  majority  of  the  dependents  appeared  to  have  passed  through 
the  Bureaus  of  Dependent  Adults,  admissions  had  also  been  made  to  all  three 
almshouses  through  other  avenues.  For  example,  dependents  were  found  to 
have  been  admitted  to  the  Manhattan  Home  through  the  Emergency  and 
ReHef  Station  of  the  Department  of  Public  Charities,  at  the  foot  of  East 
70th  Street,  and  by  some  other  avenue  that  could  not  be  ascertained.  Also, 
the  dependents  were  found  to  have  been  admitted  in  considerable  numbers 
to  the  Brooklyn  Home  by  transfer  from  Kings  County  Hospital  and,  ap- 
parently, also  by  subordinate  officials  in  the  Home  itself ;  and  at  Farm  Col- 

249 


250  HOSPITAL    COMMITTEE 

ony  some  admissions  were  made  by  the  order  of  the  Superintendent  of  the 
Colony. 

Permits  were  issued  by  the  different  Bureaus  to  be  presented  at  the  in- 
stitutions by  dependents  as  evidence  of  the  authorization  of  their  admis- 
sion. In  a  small  proportion  of  the  admissions  to  the  Manhattan  Home  these 
permits  were  lacking  from  the  files  at  the  Home  for  the  2  months  for 
which  the  examination  was  made.  In  the  case  of  23  per  cent,  of  the  admis- 
sions to  the  Brooklyn  Home  in  the  month  studied,  instead  of  the  permits 
from  the  Brooklyn  Bureau  of  Dependent  Adults,  there  were  found  in  the 
files  at  the  Home  transfer  permits  from  Kings  County  Hospital  over  the 
name  of  its  Superintendent.  Reference  to  the  records  at  this  Hospital 
showed  that  some  of  these  dependents  had  not  been  recipients  of  acute 
hospital  treatment,  and  that  some  did  not  even  appear  in  the  card  file  of 
their  discharged  patients.  Instances  of  the  use  of  this  Home  by  dependents 
as  a  lodging  house  were  also  discovered.  Such  admissions  were  said  to  be 
at  the  discretion  of  the  subordinate  officials  immediately  over  the  male  and 
female  inmates  of  the  Home.  Permits  for  admission  to  Farm  Colony  were 
found  to  have  been  issued  by  all  three  Bureaus.  The  Manhattan  Bureau, 
however,  was  said  to  have  control  over  the  transfers  from  the  Brooklyn 
Home,  although  permits  for  these  transfers  were  made  out  in  the  Brooklyn 
Bureau.  Upon  the  books  of  Farm  Colony  the  authority  recorded  for  a 
number  of  admissions  during  the  year  July  i,  191 1,  to  June  30,  1912,  was 
merely,  "By  order  of  the  Superintendent."  There  were  6  such  admissions 
in  I  of  the  2  months  for  which  examination  was  made. 

The  Manhattan  and  Brooklyn  Homes  felt  the  pressure  upon  them  of 
the  heavy  transfer  of  dependents  from  hospitals,  and  as  the  new  dormi- 
tories were  opened  at  Farm  Colony  transfers  were  made  from  these  Homes 
to  the  Colony  to  fill  the  vacancies  there  and  relieve  the  congestion  at  the 
Homes.  In  order  to  prevent  a  return  of  these  congested  conditions  by  these 
dependents  leaving  the  Colony  and  receiving  readmission  to  the  Home  from 
which  they  had  been  discharged,  it  was  adopted  as  a  policy  of  the  Bureaus 
of  Dependent  Adults  in  Manhattan  and  in  Brooklyn  to  forbid  the  read- 
mission  to  the  City  Homes  of  any  dependent  who  had  been  transferred 
to  the  Colony.  This  rule  was  incorporated  in  a  letter  written  by  the  Second 
Deputy  Commissioner  of  Charities,  in  charge  of  the  Brooklyn  office  of  the 
Department  of  Public  Charities,  under  date  of  October  7,  191 1,  in  which  he 
stated  that  it  had  been  brought  to  his  attention  that  this  policy  was  not 
being  pursued,  and  ordered  that  no  such  dependents  should  be  readmitted 
to  the  Brooklyn  Home,  but  that  all  of  them  should  be  referred  to  the  Man- 
hattan Bureau.  While  there  is  no  method  of  ascertaining  what  proportion 
of  these  dependents  that  applied  to  be  readmitted  to  the  two  City  Homes 
were  refused  such  admission,  a  study  of  over  1,500  discharges  of  dependents 
from  the  two  Homes  showed  that  in  the  case  of  a  large  proportion  of  these 
the  Bureaus  exercised  practically  no  control  that  hindered  their  reentering 
the  institutions  from  which  they  had  been  discharged  for  transfer  to  the 
Colony. 

Not  only  was  this  general  administration  policy  overridden  at  the  volition 
of  the  dependent  who  preferred  the  Home  to  Farm  Colony,  but  it  would 
seem  that  the  disciplinary  methods  which  the  Superintendent  of  the  Colony 
had  found  it  advisable  to  employ  were  rendered  more  or  less  ineffective. 
A  number  of  instances  were  found  of  dependents  who  had  been  expelled 
from  the  Colony  by  the  order  of  the  Superintendent,  yet  seemed  to  have 
had   no  difficulty  in  securing  immediate   or   early   admission   to  the   City 


ADMISSIONS   TO   CITY  HOMES  25 1 

Homes  from  which  they  had  been  transferred.  It  is  presumable  that  the 
effect  of  the  disciplinary  expulsion  was  lessened  by  the  easy  readmission 
to   another  institution. 

As  early  as  the  year  1902  the  Commissioner  of  Public  Charities  in  office 
at  that  time  set  aside  the  institution  then  known  as  the  Richmond  County 
Almshouse  under  the  new  title  of  New  York  City  Farm  Colony,  for  occu- 
pation by  the  more  able-bodied  inmates  of  the  almshouses  who  should, 
by  manual  labor,  bring  some  return  to  the  City  for  the  cost  of  their  mainte- 
nance. To  insure  an  able-bodied  population  the  mentally  and  physically 
incapable  dependents  at  that  time  in  the  Colony  were  taken  to  other  insti- 
tutions, and  individuals  that  seemed  better  fitted  for  useful  labor  upon  the 
farm  were  selected  and  transferred  to  the  Colony.  The  annual  reports  of 
the  Department  of  Public  Charities  showed  a  steady  yearly  increase  in 
the  value  of  the  crops  raised  by  these  dependents  for  several  years  after  this 
change  was  made,  and  also  showed  a  comparatively  small  proportion  of  paid 
employees  to  have  been  at  the  Colony.  This  basis  of  selection  of  inmates 
for  the  Colony  has  apparently  been  abandoned,  for  the  records  of  that  in- 
stitution showed  that  in  August,  1912,  the  crippled,  paralytic,  and  the  blind 
had  been  admitted  there  in  considerable  numbers,  and  that  over  one-third 
of  the  inmates  there  were  over  70  years  of  age. 

Although  specific  provision  was  made  in  the  Poor  Law  of  the  State  of 
New  York  for  the  keeping  of  detailed  records  of  the  dependents  admitted 
to  almshouses,  and  this  law  makes  it  mandatory  upon  the  officers  responsible 
for  the  care  and  relief  of  poor  persons  to  send  full  information  regarding 
the  dependents  with  them  to  the  almshouse  to  which  they  are  to  be  admitted, 
an  examination  of  the  records  of  the  Bureaus  of  Dependent  Adults  showed 
that  they  neither  placed  in  their  own  files  during  the  years  191 1  and  1912 
the  information  that  the  law  seems  to  require,  nor  transmitted  to  the  alms- 
houses such  information  as  was  on  the  records  of  the  Bureaus.  Far  more 
complete  histories  of  the  dependents  were  found  at  the  Manhattan  Home 
than  at  the  Bureau  of  Dependent  Adults  through  which  they  had  been 
admitted.  In  the  case  of  transfers  from  almshouse  to  almshouse  the  records 
seemed  rarely  to  have  accompanied  the  dependent,  necessitating  the  taking 
of  a  new  record  each  time. 

As  the  Department  of  Public  Charities  during  these  years  of  191 1  and 
1912  maintained  no  general  file  containing  the  names  of  public  charges  in 
municipal  institutions,  it  is  difficult  to  see  how  it  would  have  been  possible 
to  prevent  a  dependent  entering  either  of  the  Homes  in  violation  of  the 
rules  of  the  Bureaus  of  Dependent  Adults.  It  was  also  entirely  possible 
that  one  institution  or  Bureau  might  adopt  a  certain  policy  toward  an  in- 
dividual dependent  based  on  information  at  hand  while  there  might  be  con- 
tained in  the  records  of  another  almshouse  or  Bureau  information  that 
would  justify  the  pursuit  of  an  entirely  different  course  in  handling  the 
case.  As  a  matter  of  fact,  a  good  many  of  the  dependents  who  were  aliens 
were  entered  as  such  on  the  records  of  the  almshouses,  while  the  Bureaus 
had  no  such  information  recorded.  As  the  details  in  the  records  called  for 
by  law  (and  for  which  blank  forms  were  provided  by  the  State  Board  of 
Charities)  were  not  entered  upon  the  records  in  many  instances  at  Farm 
Colony,  and  these  records  were  complete  in  only  a  very  few  instances  at  the 
Brooklyn  Home,  for  the  admissions  in  the  months  stated,  it  was  impossible 
to  determine  just  what  proportion  of  the  dependents  admitted  to  these  in- 
stitutions were  aliens  or  non-residents.  Information  regarding  the  naturali- 
zation of  dependents  of  alien  birth  was  omitted  from  a  number  of  the  rec- 


252  HOSPITAL    COMMITTEE 

ords  of  the  dependents  admitted  in  2  months  to  Farm  Colony,  and  from  a 
large  proportion  of  the  records  for  the  month  studied  at  the  Brooklyn 
Home. 

An  investigation  was  made  of  833  admissions  entered  upon  the  records 
of  dependents  admitted  to  the  Manhattan  Home  in  the  months  of  December, 
191 1,  and  May,  1912;  to  the  Brooklyn  Home  in  the  month  of  j\Iay,  1912; 
and  to  Farm  Colony  in  the  months  of  December,  191 1,  and  May,  1912. 
The  investigation  revealed  that  the  addresses  of  dependents  as  recorded  at 
the  institutions  could  be  classified  as  follows : 

Residences  of  dependents  just  prior  to  admission ISO,  or  21.6% 

Residences  of  dependents  at  some  time  before  admission 38,  "  4.6% 

Addresses  where  dependents  were  not  known 196,  "  23 . 5% 

Addresses  of  lodging  houses 141,  "  16.9% 

Addresses  that  were  not  residential 4S,  "  5.8% 

Addresses  that  were  not  sufficiently  expUcit  for  investigation IS,  "  2.2% 

Addresses  that  were  outside  of  the  City 7,  "  .8% 

Dependents  admitted  without  residential  address 205,  "  24.6% 

Total 833,or  100.0% 

Upon  the  records  of  some  of  the  admissions  in  the  same  months  at  the 
same  institutions  there  were  758  addresses  of  relatives  and  friends  to  be 
communicated  with  in  case  of  necessity,  which,  after  investigation,  were 
classified  as  follows: 

Residences  of  relatives  or  friends  just  prior  to  the  admission  of  the  depend- 
ents   ; 370,  or  48.8% 

Residences  of  relatives  or  friends  at  some  time  before  the  admission ... .  30,   "     4.0% 

Addresses  where  the  relatives  or  friends  were  not  known 173,   "  22.8% 

Addresses  of  lodging  houses 28,  "     3.7% 

Addresses  that  were  not  residential 56,  "     7.4% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 35,  "     4.6% 

Addresses  that  were  outside  of  the  City 66,   "     8.7% 

Total 758,  or  100.0% 

The  charter  of  the  City  of  New  York  makes  it  mandatory  upon  the 
Commissioner  of  Public  Charities  to  investigate  the  circumstances  of  every 
person  admitted  to  the  institutions  under  his  charge,  and  also  the  near  rela- 
tives of  such  a  person.  If  practicable,  this  investigation  is  to  be  made  before 
the  admission  of  an  applicant.  A  detailed  study,  including  visits  to  the 
home  addresses  of  the  dependents  and  their  relatives  or  friends,  was  made 
of  the  following  admissions :  male  admissions  to  the  Manhattan  Home  in 
December,  1911,  amounting  to  186;  male  admissions  to  the  same  Home 
in  May,  1912,  amounting  to  253;  all  admissions  to  the  Brooklyn  Home  in 
May,  1912,  amounting  to  241  ;  all  admissions  to  Farm  Colony  in  the  month 
of  May,  1912,  amounting  to  98;  and  90  of  the  145  admissions  to  the  Colony 
in  December,  191 1. 

It  was  noticeable  that  an  extremely  small  percentage  of  these  923 
admissions  were  of  Hebrews.  The  religion  was  not  ascertained  for  103  of 
these  dependents,  owing  to  the  manner  in  which  the  records  were  kept. 
Of  the  remaining  820  cases,  however,  only  28  admissions,  or  3.4  per  cent., 
were  of  dependents  of  the  Hebrew  faith,  while  282  of  the  admissions,  or 
34.4  per  cent.,  were  of  Protestants,  and  510  admissions,  or  62.2  per  cent, 
were  of  Catholics. 

All  of  these  28  admissions  of  Hebrews  were  for  dependents  who  were 


ADMISSIONS   TO    CITY  HOMES  253 

either  paralyzed,  crippled,  sick,  or  who  had  just  been  transferred  from 
hospitals,  or  were  held  for  investigation  by  the  State  Board  of  Charities 
for  possible  removal. 

The  investigators  of  the  Committee  were  unable  to  obtain  sufficient  in- 
formation to  permit  of  the  classification  of  406  of  the  above  admissions 
because  of  the  following  reasons: 

The  addresses  found  at  the  almshouses  were  insufficient  in 107  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 219      " 

The  addresses  given  were  too  old  in 19      " 

Sufficiently  complete  histories  could  not  be  secured  in 01      " 

Total 406  Cases 

In  the  remaining  462  cases,  however,  the  information  gathered  seemed 
to  justify  their  classification  as  follows: 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon  the  City's 

support 230,  or  49.8% 

Dependents  who  were  aliens 125,  "  27 . 0% 

Dependents  who  did  not  have  a  legal  settlement  in  New  York  City 17,  "     3.7% 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 

maintenance 34,  "     7.4% 

Dependents  who  were  personally  able  to  pay  for  their  maintenance 9,   "     2.0% 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy,  or  who  were 

widows  of  men  who  had  served  in  the  U.S.  Army  or  Navy 7,   "     1.5% 

Dependents  who  had  relatives  or  friends  wilhng  to  support  them  in  their 

homes 14,  "     3.0% 

Dependents  who  were  able  to  work  to  earn  their  own  support 11,   "     2.4% 

Dependents  who  were  committed  by  magistrates  for  observation  as  to 

their  sanity 7,   "     1-5% 

Dependents  who  had  relatives  not  legally  responsible  but  able  to  pay  for 

their  maintenance 8,   "     1.7% 

Total 462,  or  100.0% 

Not  only  did  it  appear  from  the  above  classification  that  the  Bureaus 
of  Dependent  Adults  failed  to  make  investigation  of  the  applicants  for  ad- 
mission to  the  almshouses,  but  it  was  also  evident  from  comparison  of  the 
history  cards  in  the  almshouses  with  those  for  the  same  dependents  in 
the  Bureaus  that  the  Department  was  not  making  use  of  information  con- 
tained in  its  own  files.  There  was  lacking  in  the  Department  that  co- 
ordination between  the  records  in  the  Bureaus  and  the  records  in  the 
almshouses  that  would  have  made  this  information  of  use  to  the  Bureaus, 
and  would  have  served  as  a  corrective  to  both  records. 

The  expense  for  the  maintenance  of  the  above  dependents  was  esti- 
mated by  ascertaining  the  total  days  of  stay  of  all  of  the  dependents  repre- 
sented in  the  above  classification  from  the  records  of  the  institutions,  and 
obtaining  from  the  Annual  Reports  of  the  Department  of  Public  Charities 
the  amount  of  the  average  per  diem  expense  of  the  maintenance  of  each 
dependent  for  the  last  5  years.  This  maintenance  expense,  as  is  understood, 
covered  only  the  local  cost  of  maintenance  at  the  institution,  and  did  not 
include  the  general  administration  expenses  of  the  Department,  corporate 
stock  expenses,  or  any  charges  of  a  general  nature. 

These  dependents  were  segregated  into  three  groups  as  follows: 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 
maintenance. 


254  HOSPITAL   COMMITTEE 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 

The  dependents  found  to  fall  into  Group  I  remained  in  the  same  alms- 
houses into  which  they  were  admitted,  during  the  months  considered,  for  a 
period  of  40,101  days,  at  a  total  estimated  expense  to  the  City  of  $13,330.93. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 
Dependents  who  were  wives  or  children  of  men  who  had  served  in  the 
U.  S.  Army  or  Navy. 

The  dependents  in  Group  II  remained  in  the  same  almshouses  to  which 
they  were  admitted,  in  the  months  considered,  for  a  period  of  6,430  days, 
at  a  total  estimated  expense  to  the  City  of  $1,981.89. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support 

but  able  to  pay  for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their 

own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

The  dependents  in  Group  III  remained  in  the  same  institutions  to  which 
they  were  admitted,  in  the  months  considered,  for  a  period  of  4,905  days, 
at  an  estimated  expense  to  the  City  of  $1,582.27.  The  total  number  of  days 
stay  of  all  these  dependents,  as  stated,  was  51,436  days,  at  an  estimated 
expense  to  the  City  for  their  maintenance  of  $16,895.09.     (Table  XLIX.) 

The  above  estimates,  however,  cover  only  the  462  admissions  for  which 
sufficient  information  could  be  gathered  to  permit  of  their  classification. 
Accepting  the  proportions  of  the  three  groups  to  the  total  of  the  cases 
classified  for  the  entire  868  admissions  considered  (Table  L)  the  estimated 
expense  of  these  dependents  falling  into  the  same  groups  would  have  been 
as  follows : 

Group     1 330,832.25 

Group    II 3,132.40 

Group  III 3,199.79 

Total 337,164.44 

Although  under  the  Poor  Law  of  the  State  of  New  York  all  men  who 
have  served  in  the  U.  S.  Army  or  Navy  and  the  widows  or  children  of 
such  men  are  excluded  from  the  almshouses,  it  was  found  that  a  number 
of  these  were  admitted.  In  i  case  the  fact  that  the  dependent  admitted 
had  been  in  such  service  was  entered  upon  his  history  card  at  the  Bureau 
of  Dependent  Adults. 

The  State  Charities  Law  of  the  State  of  New  York  empowers  the 
State  Board  of  Charities  to  visit  any  institution  subject  to  its  supervision 
to  ascertain  if  any  of  the  dependents  there  are  non-residents  or  alien  poor, 
and  to  remove  such  dependents  to  the  state  or  country  from  which  they 
may  have  come.  It  was  found  that  of  the  dependents  admitted  to  the 
three  almshouses  in  the  months  studied,  30  per  cent,  were  alien  or  non- 
resident poor,  and  that  only  about  15  per  cent,  of  these  had  been  removed 
from  these  institutions  by  the  State  Board  of  Charities.  The  deficiency  of 
the  records  in  the  Bureaus  of  Dependent  Adults  and  in  the  almshouses  made 


ADMISSIONS   TO   CITY  HOMES  255 

it  impossible  to  ascertain  the  total  number  of  aliens  and  non-residents  rep- 
resented in  the  admissions  to  the  almshouses  in  these  months.  It  was  also 
found  that  the  Bureaus  did  not  call  the  attention  of  the  State  Board  of 
Charities  to  the  presence  of  the  majority  of  these  aliens  and  non-residents 
in  these  institutions. 

Not  only  was  the  Department  of  Public  Charities  found  to  have  insti- 
tutions more  or  less  isolated  that  might  naturally  be  supposed  would  be 
coordinated  in  coping  with  their  common  problem,  but  it  was  not  found 
to  be  seeking  the  cooperation  of  the  private  social  agencies  of  the  com- 
munity in  handling  the  adult  poor.  The  practice  that  is  understood  to  be 
followed  by  the  Bureau  of  Dependent  Children  of  furnishing  private 
charitable  societies  with  the  names  of  all  children  for  whose  maintenance 
at  public  expense  applications  had  been  made  at  this  Bureau  did  not  seem 
to  obtain  in  the  Bureaus  of  Dependent  Adults,  except  in  connection  with 
applications  made  for  admission  to  the  cottages  at  Farm  Colony.  The 
opportunity  afforded  of  cooperating  in  the  constructive  and  preventive  1,/ 
work  of  these  agencies  does  not  seem  to  have  been  sought  ,by  the  , 
Department  of  Public  Charities,  with  the  possible  exception  in  the  case 
of  the  dependents  just  mentioned.  Information  was  found  to  be  contained 
in  the  records  of  the  almshouses  that  had  been  obtained  upon  the  different 
admissions  of  the  same  dependent  which  bore  upon  the  legality  or  propriety 
of  the  admission  of  dependents,  but  little,  if  any,  effort  seemed  to  have  been 
made  to  have  the  Bureaus  of  Dependent  Adults  avail  themselves  of  this 
information.  Many  of  the  dependents  admitted  in  the  months  studied  had 
previously  been  inmates  of  municipal  institutions,  but  the  social  data  on 
their  records  seemed  to  have  been  largely,  if  not  entirely,  unused  by  the 
Bureaus. 

The  Superintendents  of  the  Bureaus  of  Dependent  Adults  seemed  to 
have  approved  or  disapproved  very  few  of  the  total  admissions  in  the 
months  examined.  Except  in  the  Manhattan  Bureau,  for  i  of  these  2 
months  practically  nothing  worthy  of  consideration  was  found  to  have 
been  done  in  this  respect.  Less  than  37  per  cent,  of  these  Manhattan  ad- 
missions in  this  month  seemed  to  have  been  approved  or  disapproved,  and 
about  one-third  of  this  37  per  cent,  seemed  to  have  been  passed  upon  only 
by  the  Examiners  of  Charitable  Institutions.  The  Superintendent  in  the 
Brooklyn  Bureau  seemed  to  have  no  supervision  or  knowledge  concerning 
the  fitness  of  each  dependent  for  admission. 

Investigations  were  not  found  to  have  been  made  by  the  Examiners 
of  Charitable  Institutions  of  any  consequence,  except  for  the  Manhattan 
Bureau,  in  i  of  the  2  months  studied,  and  then  only  for  less  than  20  per 
cent,  of  the  admissions  in  the  month.  In  some  of  these  investigations 
addresses  on  the  records  of  the  Department  were  not  visited;  information 
gathered  by  the  Committee's  investigators  was  not  obtained;  and  a  number 
of  the  recommendations  based  on  these  investigations  and  on  the  histories 
taken  in  the  Bureau  seemed  not  justified  in  the  Hght  of  the  facts  obtained 
by  the  Committee's  investigators. 


CITY  HOME  FOR  THE  AGED  AND  INFIRM,  MANHATTAN 
DIVISION 

During  the  year  191 1  the  total  admissions  of  dependents  to  this  Home 
was  4,134.  Of  these,  as  may  be  seen  by  reference  to  Table  I,  page  291.  647, 
or  15.6  per  cent,  of  the  total,  were  transfers  from  the  municipal  hospi- 
tals in  this  Department  and  in  the  Department  of  Bellevue  and  Allied  Hos- 
pitals, with  5  transferred  direct  from  Lebanon  Hospital.  The  remainder 
of  the  admissions  came  as  follows:  3,464  from  the  Bureau  of  Dependent 
Adults,  Manhattan;  19  from  the  Work  House,  Blackwell's  Island;  and 
4  from  New  York  City  Farm  Colony. 

During  the  first  6  months  of  1912  there  were  1,944  dependents  ad- 
mitted to  this  Home  (Table  11).  Of  these,  448,  or  23.5  per  cent,  of  the 
total,  were  admitted  by  transfer  from  the  municipal  hospitals;  1,482  of 
the  remainder  were  admitted  through  the  Manhattan  Bureau ;  9  were  trans- 
ferred from  the  Work  House,  Blackwell's  Island;  and  5  were  transferred 
from  Farm  Colony. 

Causes  of  Dependence 

Beginning  with  January  i,  1912,  the  causes  of  dependence  of  those  ad- 
mitted to  this  Home  have  been  entered  in  the  admission  book  of  the  insti- 
tution. These  are  said  to  have  been  gathered  from  the  statements  of  the 
dependents  upon  admission.  A  study  of  these  causes  of  dependence  showed 
that  781  of  the  dependents,  or  40.2  per  cent.,  became  such  because  of  lack 
of  employment;  815,  or  42  per  cent.,  through  sickness;  335,  or  17.2  per 
cent.,  through  age  or  infirmity;  9,  or  0.4  per  cent.,  were  blind;  2,  or  o.i 
per  cent.,  were  lost;  i  was  an  alcoholic;  and  the  cause  of  i  case  was  un- 
known.    (Table  III.) 

Avenues  of  Admission 

In  order  to  ascertain  the  conditions  governing  the  admission  of  depend- 
ents and  the  character  of  those  admitted,  a  study  was  made  of  the  total 
number  of  male  admissions  to  this  Home  during  the  month  of  December, 
191 1,  numbering  186  admissions,  and  during  the  month  of  May,  1912, 
numbering  253. 

These  dependents  were  found  to  have  been  admitted  through  the  follow- 
ing agencies : 

(a)  Manhattan  Bureau  of  Dependent  Adults,  of  the  Department  of 
Public  Charities,  directly. 

(b)  The  Examining  Physician  of  the  Department  at  the  foot  of  East 
26th  Street. 

(c)  The  Emergency  and  Relief  Station   of  the  Department   (other- 
wise known  as  the  Reception  Hospital),  at  the  foot  of  East  70th  Street. 

(d)  Transfer    from   City   and    Metropolitan    Hospitals,    Blackwell's 
Island. 

(e)  Transfer  from  Harlem  Hospital,  of  the  Department  of  Bellevue 
and  Allied  Hospitals. 

(f)  Transfer  from  New  York  City  Farm  Colony. 

(g)  Transfer  (in  i  case,  it  was  said)   from  the  list  of  employees  to 
the  register  of  dependents. 

(h)   A  channel  not  ascertained. 

256 


ADMISSIONS   TO   CITY  HOMES  257 


Authority  for  Admissions 

The  authority  for  every  admission  to  the  almshouses  is  supposed  to  em- 
anate from  the  Superintendents  of  the  Bureaus  of  Dependent  Adults.  A 
portion  of  these  cases  are  referred  to  the  Examining  Physician  for  medical 
diagnosis.  Transfers  from  City  and  Metropolitan  Hospitals  must  have 
permits  from  the  Superintendents  of  the  Bureaus  of  Dependent  Adults,  but 
the  opinion  of  the  discharging  physicians  at  the  Hospitals  upon  the  propriety 
of  the  transfer  is  accepted  as  adequate.  Transfers  were  allowed  to  be 
made  from  Harlem  Hospital  to  the  Neurological  Hospital  in  connection 
with  this  Home  by  way  of  the  Reception  Hospital  after  consent  had  been 
obtained  from  the  Superintendent  of  the  Bureau  by  telephone.  The  Super- 
intendent of  the  Bureau  did  not  know  of  the  other  cases  that  were  admitted 
through  this  Reception  Hospital. 

For  the  male  admissions  to  this  Home  during  December,  191 1,  there 
were  found  165  permits,  or  88  per  cent,  of  the  total  number  of  male  depend- 
ents, with  the  name  of  the  Superintendent  of  the  Bureau  stamped  or  written 
upon  them,  and  15  permits  from  the  Superintendent  of  the  Bureau  for  the 
examination  of  dependents  by  the  Examining  Physician  at  the  foot  of  East 
26th  Street,  countersigned  with  a  stamp  by  this  physician,  for  admission  to 
the  Home.  This  would  make  180  dependents,  or  96  per  cent,  of  the  total, 
admitted  directly  or  indirectly  over  the  name  of  the  Superintendent  of  the 
Bureau.  There  was  also  i  permit  from  the  Examining  Physician's  ofiflce 
not  countersigned. 

Five  of  the  remaining  admissions  during  this  month  were  not  recorded 
in  the  Bureau,  but  were  made  as  follows :  2  dependents  were  admitted 
by  transfer  from  Harlem  Hospital,  over  the  name  of  a  doctor  at  that 
institution ;  i  was  admitted  from  the  Emergency  and  Relief  Station,  other- 
wise known  as  Reception  Hospital,  over  the  signature  of  an  interne  con- 
nected with  Metropolitan  Hospital;  and  in  the  case  of  2  others  the  chan- 
nel of  admission  and  the  authority  therefor  could  not  be  ascertained. 
(Table  IV.) 

For  the  male  admissions  during  the  month  of  May,  1912,  there  were 
found  142  permits  bearing  the  name  of  the  Superintendent  of  the  Bureau 
alone  upon  them,  and  loi  bearing  also  the  name  of  the  Examining  Physi- 
cian. Thus,  243  of  the  total  were  admitted  directly  or  indirectly  over  the 
name  of  the  Superintendent  of  the  Bureau  of  Dependent  Adults. 

There  were  found  the  following  cases  for  this  month  without  permits 
from  the  Bureau :  4  transfers  from  Harlem  Hospital,  over  the  name  of  a 
doctor  there;  4  admissions  through  the  Emergency  and  Relief  Station  at 
70th  Street,  over  the  name  of  an  interne  or  a  doctor  on  Blackwell's  Island ; 
I  admission  from  Farm  Colony,  over  the  name  of  its  Superintendent ;  and 
I  dependent  who  was  said  to  have  been  transferred  from  the  list  of  em- 
ployees to  the  register  of  the  dependents.     (Table  V.) 

Although  permission  was  supposed  to  have  been  asked  by  telephone  of 
the  Bureau  for  the  above  4  transfers  from  Harlem  Hospital  in  these  2 
months,  record  could  be  found  of  only  i  of  them  at  the  Bureau.  No  record 
whatever  was  found  at  the  Bureau  for  the  4  cases  admitted  by  different 
doctors  through  the  Reception  Hospital.  One  of  these  cases  was  said  by  a 
relative  to  have  been  sent  by  a  private  physician  in  the  City  through  the 
Emergency  and  Relief  Station ;  another  was  an  individual  of  some  personal 
means  whose  treatment  was  afterward  paid  for  in  another  institution;  a 


258  HOSPITAL   COMMITTEE 

third  had  been  a  paying  patient  in  a  private  institution  for  a  long  time  prior 
to  this  admission ;  and  the  remaining  case  was  that  of  an  ahen.    (Table  VI.) 

In  the  case  of  the  dependent  referred  to  above  as  having  been  transferred 
from  Farm  Colony  to  the  Home  without  a  permit,  there  could  be  found 
no  record  of  any  kind  at  the  Bureau  of  Dependent  Adults.  The  dependent 
said  to  have  been  transferred  from  the  position  of  employee  to  a  place 
among  the  dependents  was  not  found  to  be  listed  among  the  employees  of 
the  institution  on  the  Civil  List,  covering  this  period,  compiled  at  the  institu- 
tion and  published  by  the  City  Record.  According  to  the  records  of  this 
Home  this  was  his  19th  admission  as  a  dependent  at  this  one  institution. 
One  of  the  dependents  admitted  in  the  month  of  December  by  a  channel 
not  ascertained  was  found  to  have  been  transferred  twice  previously  from 
this  Home  to  Farm  Colony.  This  readmission,  for  which  no  authority  could 
be  ascertained,  was  in  violation  of  a  rule  of  the  Bureau  of  Dependent 
Adults. 

According  to  the  records,  2  of  these  dependents  admitted  during  Decem- 
ber and  3  during  May  were  admitted  to  this  Home  the  day  preceding  the 
issuance  of  the  permit. 

Effort  was  made  at  the  Bureau  to  discover  what  records  existed  there 
of  the  permits  for  these  dependents.  Nothing  could  be  learned  in  this 
regard  for  the  month  of  December,  191 1,  as  no  stubs  for  such  permits 
could  be  found,  but  for  the  month  of  May,  1912,  there  were  found  134 
permit  stubs  corresponding  to  134  of  the  141  permits  at  the  Home  for 
this  month  bearing  the  name  of  the  Superintendent.  Permit  stubs  could  not 
be  located  for  any  of  the  remainder  of  the  male  admissions  for  this  month. 

Control  of  Admissions 

In  violation  of  what  was  said  to  be  the  rule  of  the  Bureau  of  Dependent 
Adults  that  no  dependent  who  had  been  transferred  to  Farm  Colony  from 
this  Home,  or  had  been  discharged  from  there  for  refusing  such  transfer, 
should  be  readmitted  to  any  other  institution  than  Farm  Colony,  it  was 
discovered  that  of  the  total  of  554  dependents  discharged  for  transfer  to  the 
Colony  from  January  i,  1910,  to  June  30,  1912,  103  had  been  readmitted  to 
this  Home  (Summary  I  on  page  294  and  Table  VII).  Practically  all 
of  these  103  were  readmitted  through  the  Bureau,  and  less  than  13  per  cent, 
of  them  were  sent  to  Farm  Colony  again  at  the  end  of  this  first  stay  after 
readmission  (Table  VIII).  A  number  of  these  came  back  and  forth  to 
the  Home,  through  the  Bureau,  as  many  as  half  a  dozen  times  without 
being  returned  to  the  Colony  (List  i  on  page  301).  Not  only  was  this 
true  of  these  dependents  after  their  first  discharge  for  transfer  to  Farm 
Colony,  but  it  was  also  true  of  the  same  individuals  in  a  limited  number  of 
cases  after  their  second  and  third  discharges  for  transfer  to  the  Colony. 

It  would  appear  that  the  disciplinary  methods  that  the  Superintendent 
of  Farm  Colony  had  found  it  advisable  to  employ  were  by  this  means  made 
more  or  less  inefifective,  for  of  the  first  103  admissions  of  such  transfers,  7 
had  left  the  Colony  by  order  of  the  Superintendent,  and  46  were  recorded 
upon  the  books  of  the  Colony  as  having  absconded  from  there ;  that  is,  having 
left  the  institution  without  receiving  discharge  through  the  Superintendent 
(Table  VIII).  Six  were  found  to  have  been  readmitted  to  the  Home  while 
absent  from  the  Colony  on  a  pass,  and  were  recorded  upon  the  books  of  the 
Colony  as  having  terminated  their  stay  there  by  overstaying  their  passes 
for  a  leave  of  absence  from  the  institution.    All  of  these  dependents  read- 


ADMISSIONS   TO   CITY  HOMES  259 

mitted  to  the  Home  after  their  second  discharge  for  transfer  from  there 
to  the  Colony  had  absconded  from  the  Colony,  and  the  i  who  was  readmitted 
to  the  Home  after  his  third  transfer  to  the  Colony  had  been  expelled  from 
the  Colony  by  order  of  the  Superintendent. 

In  all  that  has  been  said  above  regarding  the  readmissions  to  this  Home 
of  those  transferred  to  Farm  Colony,  it  must  be  borne  in  mind  that  only 
those  readmissions  were  taken  into  account  where  the  inmate  had  given  the 
same  name  as  upon  his  previous  admission.  No  provision  existed,  so  far 
as  is  known,  for  the  detection  of  a  readmission  of  a  person  who  entered 
under  an  alias,  and  there  is  no  means  of  computing  what  the  actual 
number  of  readmissions  of  these  dependents  to  this  institution  really  was. 
The  number  of  entries  of  these  same  dependents  to  the  various  other  mu- 
nicipal institutions  is  also  unknown. 

As  these  dependents  are  transferred  to  Farm  Colony  to  fill  vacancies 
at  that  institution  and  to  relieve  congestion  at  this  Home,  the  policy  of 
the  Department  has  been  interfered  with  by  their  readmission  to  the  insti- 
tution from  which  they  were  transferred,  and  they  contribute  toward  a 
return  of  the  congestion  which  their  transfer  was  designed  to  relieve. 
Although  their  disposition  in  leaving  the  Home  for  the  transfer  was  re- 
corded at  this  Home,  and  in  the  year  1912  supposedly  at  the  Bureau  of 
Dependent  Adults  also,  so  that  in  all  of  the  108  readmissions  shown  in 
Table  VH  the  violation  of  the  rule  of  the  Bureau  could  have  been  detected, 
these  dependents  themselves,  rather  than  those  in  authority  over  the  institu- 
tions, seem  to  have  had  the  power  to  choose  where  they  would  be  public 
charges. 

The  system  of  records  of  dependents  at  the  Manhattan  Bureau  did  not 
provide  for  the  prevention  of  this  disregard  of  the  rule  of  the  Bureau. 
There  was  no  general  index  file  for  the  names  of  dependents  admitted 
to  almshouses,  but  the  cards  for  the  dependents  admitted  to  the  Manhattan 
Home  and  Farm  Colony  were  kept  separately,  and  further  divided  into  two 
classes  under  each  institution,  those  remaining  in  the  institution  being  in 
one  class,  and  those  who  had  left  or  who  had  died  being  in  the  other.  But 
even  these  index  files  had  been  kept  in  this  form  only  for  the  year  1912, 
and  they  were  by  no  means  complete.  Practically  no  reference  record 
existed  at  the  Bureau  of  dependents  admitted  to  almshouses  prior  to  1912. 

In  the  study  of  all  the  male  admissions  to  this  Home  in  the  month 
of  May,  1912,  further  knowledge  was  gained  regarding  the  handling  of 
the  readmissions  after  transfer  to  Farm  Colony.  Of  253  such  admissions 
in  May,  20  were  readmissions  of  these  transfers.  In  the  case  of  8  of  these, 
history  records  were  taken  and  reviewed  by  either  the  Superintendent  of 
the  Bureau  of  Dependent  Adults  or  by  one  of  his  Examiners  of  Charitable 
Institutions,  and  7  of  these  8  were  approved  to  be  admitted  as  dependents 
in  this  Home.  No  evidence  could  be  discovered  of  any  effort  made  at  the 
Bureau  to  look  up  the  previous  histories  of  these  inmates  or  even  to  learn 
whether  they  had  ever  before  been  in  Farm  Colony  or  any  other  institution. 

History  Records 

For  the  year  191 1  no  record  file  of  histories  with  financial  and  social 
data  was  kept  at  the  Bureau  of  Dependent  Adults  for  the  inmates  ad- 
mitted to  this  Home.  A  few  details  regarding  the  dependents  were  pro- 
vided for  on  the  permit  for  admission  to  the  Home;  such  as  nativity,  age, 
occupation,  residence  in  City  and  country;  but  little,  if  any,  effort  was 


26o  HOSPITAL   COMMITTEE 

made  to  obtain  statements  regarding  the  financial  ability  or  inability  of 
the  applicants  and  of  their  relatives  to  relieve  the  City  of  the  cost  of 
their  maintenance. 

During  1912,  however,  effort  is  said  to  have  been  made  to  secure  a 
history  record  at  the  Bureau  of  Dependent  Adults  for  every  applicant  ad- 
mitted to  this  institution.  For  the  253  males  admitted  during  the  month  of 
May,  1912,  there  were  found  217  history  cards  in  the  file  at  the  Bureau. 
For  the  remaining  36  cases  25  stubs  of  permits  were  found  at  the  Bureau, 
but  no  history  cards.  The  remaining  11  cases  without  histories  were  as 
follows:  I  for  whom  an  admission  permit  was  signed  by  the  Examining 
Physician ;  2  for  whom  there  were  permits  from  the  Superintendent  of  the 
Bureau  of  Dependent  Adults,  but  for  whom  there  was  no  permit  stub  at  the 
Bureau;  3  transfers  from  Harlem  Hospital;  4  admissions  through  the 
Reception  Hospital  on  70th  Street ;  i  admission  on  the  order  of  the  Superin- 
tendent of  Farm  Colony.     (Tables  IX  and  X.) 

The  entries  made  upon  the  history  cards  indicate  that  the  histories  of 
these  inmates  were  reviewed  by  the  Superintendent  of  the  Bureau  or  one  of 
his  Examiners  in  only  loi  of  these  May  cases.  In  less  than  one-half  of 
these  loi  cases  does  any  actual  investigation  seem  to  have  been  made 
outside  of  the  office.  In  other  words,  of  these  253  admissions  in  May, 
less  than  86  per  cent,  were  found  to  have  had  history  cards  made  out  for 
them;  less  than  42  per  cent,  appear  to  have  been  reviewed  by  the  Superin- 
tendent of  the  Bureau,  or  an  Examiner ;  and  less  than  20  per  cent,  appear 
to  have  had  the  history  taken  in  the  office  confirmed  or  corrected  by  investi- 
gation.    (Table  X.) 

Of  these  May  cases,  103,  or  over  40  per  cent.,  according  to  their  state- 
ments on  record  at  this  Home,  had  previously  been  dependents  in  one  or 
more  of  the  municipal  hospitals  or  almshouses,  yet  no  reference  to  the 
previous  histories  of  the  same  dependents  was  discovered  on  the  history 
cards  at  the  Bureau  for  May,  1912,  and  little  effort  to  look  up  previous 
information  was  discernible. 

The  system  of  records  kept  at  this  Home  regarding  the  dependents, 
while  not  containing  detailed  information  about  the  financial  ability 
of  the  dependents  and  their  relatives,  was  the  most  complete  in  the  three 
almshouses  in  the  City  of  New  York.  Considerable  effort  had  evidently 
been  made  to  look  up  previous  admissions  of  dependents  and  to  connect 
them  with  the  most  recent  one.  This  institution  also  kept  a  daily  admission 
book  and  a  daily  discharge  book.  It  lacked,  however,  a  card  census  of 
inmates  to  show  their  location  in  the  Home.  The  detailed  histories  of  the 
dependents  are  kept  in  a  State  history  book,  required  by  the  State  Board 
of  Charities  in  conformity  with  the  law,  and  the  records  of  the  various 
admissions  of  the  dependents  are  entered  upon  the  forms  in  this  history 
book. 

The  addresses  on  record  at  this  Home  of  the  residences  of  the  depend- 
ents, and  their  relatives  or  friends  who  were  to  be  communicated  with  in 
case  of  necessity,  did  not  seem  to  be  up  to  date.  In  a  considerable  number 
of  cases  in  which  the  dependents  had  been  in  the  institution  a  number  of 
times  the  residence  addresses  given  on  some  earlier  admission  remained  un- 
changed, although  the  dependent  might  not  have  resided  there  for  a  number 
of  years.  An  analysis  of  166  records  at  this  Home  of  dependents  admitted 
during  December,  191 1,  was  made  after  the  Committee's  investigators  had 
attempted  to  gather  information  regarding  them,  and  only  20,  or  12  per 
cent.,  of  the  addresses  entered  upon  these  records  as  the  residences  of  the 


ADMISSIONS   TO   CITY  HOMES  261 

dependents  were  found  to  have  been  their  residences  just  prior  to  their 
admission  at  this  time  to  the  Home;  3,  or  1.8  per  cent.,  were  addresses 
which  the  dependents  had  left  a  considerable  time  before  their  admission; 
while  35,  or  21  per  cent.,  were  addresses  where  the  dependents  were  not 
known.  A  considerable  proportion  of  the  addresses,  49,  or  29.5  per  cent., 
were  lodging  house  addresses,  and,  therefore,  of  little  value.  In  9  cases,  or 
5.5  per  cent,  the  addresses  given  were  false  as  residence  addresses ;  3,  or 
1.8  per  cent,  were  addresses  outside  of  New  York  City;  and  the  addresses 
for  4,  or  2.4  per  cent.,  of  these  cases  were  not  sufficiently  explicit  for  a  visit 
Among  these  166  records  were  43,  or  26  per  cent.,  upon  which  no  resi- 
dential address  of  the  dependents  were  entered.     (Table  XI.) 

A  similar  study  of  161  addresses  entered  upon  the  records  of  dependents 
admitted  to  this  Home  in  the  same  month  shows  that  only  65,  or  40.4  per 
cent.,  of  the  addresses  given  as  the  residences  of  friends  and  relatives  were 
in  fact  the  places  of  abode  of  these  dependents  just  prior  to  their  admission. 
At  9,  or  5.6  per  cent.,  of  the  addresses  the  friends  had  not  lived  for  a  con- 
siderable time  previous  to  these  admissions;  and  they  were  unknown  at 
40,  or  24.8  per  cent.,  of  the  places  given  as  their  residences.  In  21,  or  13 
per  cent,  of  the  cases  the  addresses  were  outside  of  New  York  City ;  12,  or 
7.5  per  cent.,  of  the  addresses  were  visited  and  found  not  to  be  residential ; 
8,  or  5  per  cent,  were  lodging  houses ;  and  6,  or  3.7  per  cent.,  of  the 
addresses  were  not  sufficiently  definite  to  permit  of  a  visit  being  made 
(Table  XII).  Also,  during  this  month  35  of  the  186  males  admitted,  or  19 
per  cent.,  entered  the  Home  without  giving  the  name  and  residence  of  any 
friend  or  relative. 

On  investigation  by  the  Committee  at  addresses  given  on  the  records  at 
the  institution  of  231  dependents  admitted  in  May,  1912,  as  the  residences 
of  inmates,  only  62,  or  26.9  per  cent.,  were  found  to  have  been  the  actual 
addresses  of  the  dependents  just  prior  to  their  admission.  In  the  case  of 
approximately  the  same  number,  60  addresses,  or  26  per  cent,  of  the  total, 
the  dependents  were  not  even  known  at  the  addresses.  In  addition  to 
these,  55,  or  23.9  per  cent,  of  the  total,  were  lodging  house  addresses, 
which,  on  account  of  the  meager  information  obtainable  about  the  lodgers 
at  such  places,  are  of  practically  no  value.  Thirty-six,  or  15.6  per  cent.,  of 
these  231  dependents  were  allowed  to  enter  the  institution  without  supplying 
any  residence  address ;  10,  or  4.3  per  cent.,  were  found  to  have  given  false 
addresses,  such  as  would  correspond  to  vacant  lots,  etc. ;  at  4,  or  1.7  per 
cent.,  addresses  the  dependent  had  lived  at  a  considerable  time  before  this 
admission  to  the  institution;  addresses  in  3,  or  1.2  per  cent.,  cases  were 
insufficient  for  investigation;  and  I,  or  0.4  per  cent.,  was  outside  of  New 
York  City.     (Table  XIII.) 

Upon  the  records  of  the  same  dependents,  admitted  during  this  month 
of  May,  there  were  246  addresses  of  their  relatives  or  friends,  which, 
after  investigation,  were  analyzed  as  follows :  137,  or  55.6  per  cent., 
were  found  to  have  been  the  actual  residences  of  relatives  or  friends  of 
dependents;  50,  or  20.2  per  cent.,  were  addresses  where  these  relatives  or 
friends  were  not  known;  16,  or  6.5  per  cent.,  of  the  addresses  were  not 
residential ;  9,  or  3.6  per  cent.,  were  found  to  be  addresses  where  the  rela- 
tives or  friends  had  lived  at  a  considerable  time  before  the  admission  of  the 
dependents;  and  12,  or  4.8  per  cent,  of  the  total,  were  lodging  house 
addresses.  Of  the  balance  of  the  246  addresses,  7,  or,  2.8  per  cent.,  were 
insufficient  for  investigation  and  15,  or  6.5  per  cent,  were  outside  of  the 
city  (Table  XIV).    Also,  26  dependents,  or  10  per  cent,  of  the  total  males 


262  HOSPITAL   COMMITTEE 

admitted  in  this  month,  came  into  the  institution  without  supplying  the  name 
and  residence  of  any  relative  or  friend  to  be  communicated  with  in  case 
of  necessity. 

Because  of  inability  to  secure  the  information  desired  from  the  addresses 
given  on  the  records  it  became  necessary  for  a  number  of  dependents  to  be 
interviewed  at  the  Home.  It  was  noticed  after  this  that  in  the  case  of  some 
of  these  dependents  new  addresses  were  placed  upon  the  records  of  the 
institution. 

Character  of  Dependents 

Section  663  of  the  Charter  of  the  City  of  New  York  reads  in  part  as 
follows : 

It  shall  be  the  duty  of  the  Commissioner  of  Public  Charities  to  investigate  the 
circumstances  of  every  person  admitted  to  an  institution  under  his  charge  and  of  the 
near  relatives  of  such  person.  Such  investigation  shall  be  made,  when  practicable, 
before  the  admission  of  such  person,  and  the  results  of  the  investigation  shall  be  placed 
on  file  and  preserved  with  the  records  of  the  department .... 

All  of  the  male  admissions  to  this  Home  in  the  month  of  December, 
191 1,  amounting  to  186,  and  in  the  month  of  May,  1912,  amounting  to  253, 
were  taken  up  for  investigation,  to  determine,  if  practicable,  the  legality 
or  the  propriety  of  their  dependence  upon  the  City. 

For  99,  or  53.5  per  cent,  of  the  December  admissions,  sufficient  in- 
formation could  not  be  gathered  by  the  Committee's  investigators  to  de- 
termine whether  or  not  these  were  properly  dependent.  The  reasons  for 
this  inability  were  as  follows : 

The  addresses  found  at  the  Home  were  insufficient  in 37  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 40      " 

The  addresses  given  were  too  old  in 3      " 

Sufficiently  complete  histories  could  not  be  secured  in 19      " 


Total 99  Cases 

(a)  Classification  of  Dependents 

For  the  remaining  87  male  admissions  in  this  month,  however,  sufficient 
information  was  secured  to  enable  their  classification  as  follows : 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon  the  City's 

support 29,  or  33.3% 

Dependents  who  were  aliens 38,   "  43 . 6% 

Dependents  who  did  not  have  a  legal  settlement  in  New  York  City 12,   "  13.8% 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 

maintenance 2,   "     2.3% 

Dependents  who  were  personally  able  to  pay  for  their  maintenance 2,   "     2.3% 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy 2,  "     2.3% 

Dependents  who  had  relatives  willing  to  support  them  in  their  own  homes  1,   "     1.2% 

Dependents  who  were  able  to  work  to  earn  their  own  support 1,   "     1.2% 

Total 87,  or  100.0% 

(b)  Estimate  of  Expense 

An  estimate  of  the  expense  to  the  City  of  maintaining  these  87  depend- 
ents was  made.  The  history  books  of  the  institution  were  searched 
for  all  the  entries  of  these  same  dependents  under  the  same  names.  The 
number  of  days  of  stay  for  each  admission  was  then  ascertained  and  the 
sum  of  the  days  for  all  the  admissions  was  computed  from  this.    The  stay 


ADMISSIONS   TO   CITY   HOMES  263 

of  those  dependents  who  were  in  the  institution  at  the  time  of  this  search 
was  counted  only  to  the  day  on  which  the  search  was  made.  To  arrive  at 
the  per  capita  per  diem  expense  of  each  of  these  dependents  the  per  capita 
per  diem  expense  given  by  the  Department  in  its  Annual  Reports  for  the 
last  5  years  for  this  institution  was  taken,  and  the  average  for  this  period 
was  used  as  the  multiplier  in  calculating  at  what  expense  these  dependents 
had  been  maintained  for  these  days.  As  a  matter  of  fact,  as  it  is  under- 
stood, this  per  capita  per  diem  expense  appearing  in  the  Annual  Reports 
merely  covers  the  maintenance  expense  of  the  dependents  at  the  institution 
and  does  not  include  any  portion  of  the  general  administration  expense 
of  the  Department,  corporate  stock  expense,  transportation  expense,  or 
other  expense  of  a  general  nature.  It  is  apparent,  therefore,  that  the  figures 
given  in  the  following  estimate  only  partially  represent  the  actual  expense 
to  the  City  for  the  maintenance  of  these  particular  dependents. 

These  87  dependents  were  segregated  into  three  groups  as  follows : 

Group  I. 
Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 

maintenance. 
Dependents  who  were  personally  able  to  pay  for  their  maintenance. 
Dependents  who  were  aliens. 
Dependents  who  were  non-residents  of  the  City. 
The  dependents  in  Group  I  remained  in  this  Home,  after  their  various 
admissions,  17,794  days,  at  an  estimated  expense  to  the  City  of  $5,363.11. 

Group  II. 
Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 
Dependents  who  were  wives  or  children  of  men  who  had  served  in  the 
tJ.  S.  Army  or  Navy. 

The  dependents  in  Group  II  remained  in  this  Home  a  total  of  782  days, 
at  an  estimated  expense  for  maintenance  of  $235.69. 
Group  III. 
Dependents  who  had  relatives  not  legally  responsible  for  their  support 

but  able  to  pay  for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their 

own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

The  dependents  in  Group  III  remained  in  this  Home  340  days,  at  an 
estimated  expense  of  $102.48. 

This  would  make  a  total  estimated  expense  to  the  City  for  the  mainte- 
nance of  the  dependents  in  these  three  groups  of  $5,701.28.  (Table  XVI.) 
The  above  figures,  however,  apply  only  to  those  87  cases  in  which  it  was 
possible  to  gather  sufficient  information  for  the  classification  of  the  de- 
pendents. Accepting  the  proportions  of  the  various  groups  to  the  total  of 
the  87  cases  classified  for  the  186  admissions  during  this  month,  the  esti- 
mated cost  of  the  dependents  would  have  been  as  follows: 

Group     I $10,726.22 

Group   II 471.38 

Group  III 204.96 

Total $11,402.56 

The  investigation  of  the  253  admissions  of  males  in  May  enabled  the 
classification  of  a  larger  proportion  of  the  dependents  admitted  in  this  month 


264  HOSPITAL   COMMITTEE 

than  of  those  admitted  in  December.  However,  87,  or  34.3  per  cent.,  of 
the  admissions  in  May  could  not  be  classified  because  sufficient  informa- 
tion could  not  be  gathered,  for  the  following  reasons : 

The  addresses  found  at  the  Home  were  insufficient  in 24  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 43      " 

The  addresses  given  were  too  old  in 1  Case 

Sufficiently  complete  histories  could  not  be  secured  in 19  Cases 


Total 87  Cases 

(aa)     Classificatioii  of  Dependents 

For  the  remaining  166  admissions  of  males  for  this  month,  however, 
sufficient  information  was  secured  to  enable  their  classification  as  follows : 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon  the  City's 

support 86,  or  51.8% 

Dependents  who  were  aliens 60,  "  30.2% 

Dependents  who  did  not  have  a  legal  settlement  in  New  York  City ... .  4,  "  2.4% 
Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 

maintenance 11,  "  6.6% 

Dependents  who  were  personally  able  to  pay  for  their  maintenance  ...  .  2,  "  1.2% 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy 3,  "  1.8% 

Dependents  who  were  able  to  work  to  earn  their  own  support 4,  "  2.4% 

Dependents  who  had  relatives  willing  to  support  them  in  their  own  homes  2,  "  1.2% 
Dependents  who  had  relatives  not  legally  responsible  but  able  to  pay  for 

their  maintenance 4,  "  2.4% 

Total 166,  or  100.0% 

(bb)  Estimate  of  Expense 

These  dependents  were  divided  into  three  groups,  constituted  as  those 
in  December.  The  dependents  in  Group  I  remained  in  the  Home  an  aggre- 
gate of  12,587  days,  at  a  cost,  computed  similarly  to  that  in  December,  of 
$3,793.72.  The  dependents  in  Group  H  remained  in  the  Home  an  aggre- 
gate of  5,242  days,  at  a  cost  of  $1,579.94.  The  dependents  in  Group  HI 
remained  in  the  Home  an  aggregate  of  1,590  days,  at  a  cost  of  $485.52,  ag- 
gregating for  the  total  cost  of  the  three  groups,  $5,859.18. 

Accepting,  as  was  done  for  the  month  of  December,  the  proportions  of 
the  various  groups  to  the  total  cases  classified  for  the  253  admissions  during 
May,  the  estimated  cost  of  these  dependents  would  have  been  as  follows : 

Group     I §5,774.30 

Group    II 2,404.73 

Group  III 739.00 

Total S8,918.0S 

(c)     United  States  Soldiers  and  Their  Families 

Section  80  of  Article  6  of  the  Poor  Law  of  the  State  of  New  York  reads 
in  part  as  follows  : 

No  poor  or  indigent  soldier,  sailor  or  marine  who  has  served  in  the  military  or 
naval  service  of  the  United  States,  nor  his  family,  nor  the  families  of  any  who  may  be 
deceased,  shall  be  sent  to  any  almshouse,  but  shall  be  relieved  nd  provided  for  nt  their 
homes  in  the  city  or  town  where  they  may  reside,  so  far  as  practicable,  provided  such 
soldier,  saUor,  or  marine,  or  the  families  of  those  deceased,  are,  and  have  been,  residents 
of  the  State  for  one  year.    .    .    . 


ADMISSIONS   TO   CITY  HOMES  265 

In  spite  of  this  Act  excluding  from  the  almshouses  all  who  have  served 
in  the  Army  and  Navy  of  the  United  States,  2  soldiers,  as  shown  in  the 
"Classification  of  Dependents,"  were  admitted  in  the  month  of  December 
to  this  institution,  where  it  appears  from  the  record  that  this  was  the  eighth 
admission  at  this  Home  for  i  of  them.  During  the  month  of  May  there 
were  2  admitted  who  had  served  in  the  U.  S.  Army,  and  i  who  had  served 
in  the  U.  S.  Navy.  One  of  these  was  admitted  to  the  institution  despite 
the  entry  upon  the  record  at  the  Bureau  of  Dependent  Adults  for  this 
admission  of  the  fact  that  he  was  a  soldier.  The  records  showed  that  this 
was  the  sixth  admission  for  another  of  these  dependents  at  this  institution. 

(d)     Removal  of  Aliens  and  Non-Residents 

Section  17  of  Article  2  of  the  State  Charities  Law  reads  in  part  as 
follows : 

The  State  Board  of  Charities,  and  any  of  its  members  or  officers,  may,  at  any 
time,  visit  and  inspect  any  institution  subject  to  its  supervision  to  ascertain  if  any 
inmates  supported  therein  at  a  state,  county  or  municipal  expense  are  state  charges, 
non-residents  or  alien  poor;  and  it  may  cause  to  be  removed  to  the  state  or  country 
from  which  he  came  any  such  non-resident  or  alien  poor  found  in  any  such  institu- 
tion. 

During  the  month  of  December,  191 1,  there  were  38  aliens  and  12  non- 
residents admitted  to  this  Home;  31,  or  86.9  per  cent.,  of  these  aliens  ap- 
peared on  the  records  as  such,  and  10,  or  83.3  per  cent.,  of  the  non-residents 
appeared  on  the  books  at  the  Home  as  non-residents  of  New  York  State. 

In  the  Bureau  of  Dependent  Adults  a  card  file  is  kept  of  all  alleged 
aliens  or  non-residents  reported  to  the  State  Board  of  Charities  for  exam- 
ination and  removal  in  accordance  with  the  powers  of  the  Board  set  forth 
above.  From  this  file  it  appeared  that  only  6  of  the  aliens  and  8  of  the 
non-residents  admitted  in  this  month  were  reported  to  the  State  Board  of 
Charities  by  the  Bureau.  Three  of  the  6  aliens  were  removed  by  the  Board, 
according  to  their  monthly  reports  of  removals,  and  i  was  removed  by  the 
Federal  Government.  It  would  appear  from  these  same  monthly  reports 
that  the  State  Board  of  Charities  removed  5  more  of  these  38  aliens,  whose 
names  are  not  in  the  file  at  the  Bureau  of  Dependent  Adults  as  having 
been  reported  to  the  State  Board  of  Charities  in  connection  with  their  ad- 
mission to  this  institution.  Of  the  8  non-residents  reported  by  the  Bureau 
to  the  Board,  only  4  were  removed  by  the  State  Board  of  Charities,  accord- 
ing to  their  report.  But  3  more  of  the  12  non-residents  admitted  to  this 
Home  during  this  month  were  reported  by  the  Board  as  removed,  although 
they  do  not  appear  in  the  Bureau  of  Dependent  Adults'  file  as  having  been 
reported  to  the  Board  for  removal  in  connection  with  their  admission  to 
this  institution. 

During  the  month  of  May  50  aliens  and  4  non-residents  were  admitted 
to  this  Home,  all  of  whom  appeared  as  aliens  and  non-residents  on  the 
Home  records.  Only  10  of  the  aliens  seemed  to  have  been  reported  to  the 
State  Board  of  Charities  and  none  of  the  non-residents.  The  State  Board 
of  Charities'  monthly  reports  show  the  removal  of  only  4  of  these  aliens. 
One  alien  was  removed  by  the  Government  for  whom  there  appears  no 
record  of  report  by  the  Bureau  of  Dependent  Adults  to  the  State  Board 
in  connection  with  this  admission,  and  another  non-resident  was  removed 
by  the  State  Board  for  whom  there  appeared  no  record  in  the  file  of  cases 
reported  to  the  State  Board  at  the  Bureau  of  Dependent  Adults. 


266  HOSPITAL   COMMITTEE 

The  registers  of  this  Home  were  examined  to  learn  whether  these  aliens 
had  been  in  this  Home  because  of  need  of  medical  treatment.  From  these 
books,  of  the  38  aliens  and  12  non-residents  admitted  in  December,  191 1, 
only  4  aliens  and  3  non-residents  were  found  to  have  been  in  the  hospital 
wards  in  connection  with  this  Home,  and  of  the  50  aliens  and  4  non-resi- 
dents admitted  during  May,  1912,  only  5  aliens  and  2  non-residents  were 
found  to  have  been  in  these  wards. 

(e)     Comparison  of  Findings 

The  records  of  the  Bureau  of  Dependent  Adults  showed  that  a  number 
of  the  cases  investigated  by  the  Committee's  field  workers  had  also  been 
investigated  by  the  Examiners  of  Charitable  Institutions,  under  the  Super- 
intendent of  the  Bureau.  These  cases  were  investigated  for  the  month  of 
May,  1912,  only,  little  or  no  attempt  having  been  made  by  the  Bureau  to 
investigate  the  admissions  to  this  Home  during  the  month  of  December, 
191 1.  A  comparison  of  some  of  these  cases  follows,  under  the  Committee's 
case  numbers  instead  of  under  the  names  of  the  dependents. 

Case  24.  The  Committee's  investigator  learned  that  this  inmate  owned  a  small 
drug  store  and  had  been  receiving  treatment  from  private  physicians  after  dis- 
charge from  this  Home.  Also,  that  he  had  a  son  earning  about  $35.00  a  week. 
The  report  of  the  Examiner  of  Charitable  Institutions  of  the  Department  also 
showed  this  man  to  have  been  the  owner  of  a  drug  store  and  considered  by  the 
clerk  in  charge  as  being  able  to  pay.  The  finding  of  the  Examiner  was  recorded 
as  "N.F.,"  interpreted  as  "Not  found  at  address  given."  Another  entry  upon  the 
history  of  this  case  was  "Not  approved,"  interpreted  to  mean  that  the  dependence 
of  this  individual  upon  the  City  was  not  approved.  There  was  no  record  upon  it 
of  a  visit  to  the  address  of  the  friend  from  whom  the  Committee's  investigator 
obtained  information.  This  case  was,  however,  finally  approved,  according  to  the 
entry  made  upon  the  record.     This  dependent  remained  43  days  in  the  institution. 

Case  so.  The  Committee's  investigator  was  informed  by  the  patient's  mother 
that  his  brother  was  proprietor  of  an  automobile  business.  There  was  no  record  of 
this  fact  upon  the  history  obtained  by  the  Examiner  of  the  Bureau,  and  the  case 
was   approved  without  evidence   of   any  effort   to  communicate  with   the   brother. 

Case  55.  This  dependent's  wife  said  that  he  was  able-bodied  and  went  to  this 
Home  because  she  refused  to  allow  the  children  to  support  him  in  idleness.  He 
was  working  at  the  time  of  the  investigator's  visit,  contributing  $7.00  a  week  toward 
the  family's  expenses.  There  were  3  children  in  the  family  employed  and  I  tem- 
porarily out  of  employment.  The  Home  records  showed  that  this  dependent  was 
an  alien.  The  Examiner  of  the  Department  reported  that  the  3  children  were  em- 
ployed and  that  the  family  was  considered  able  to  pay.  This  case  was  marked  ap- 
proved for  dependence  in  the  City  Home.  No  evidence  could  be  discovered  that  the 
State  Board  of  Charities  was  requested  to  make  an  examination  of  this  dependent 
as  a  possible  subject  for  deportation. 

Case  56.  The  Committee's  investigator  and  the  Examiner  of  the  Department 
of  Charities  were  alike  unable  to  gather  information  regarding  the  dependent  or 
his  friend  at  the  address  given.  The  records  of  this  Home,  however,  showed  that 
this  dependent  was  an  alien,  and  that  no  evidence  could  be  discovered  that  the  State 
Board  of  Charities  was  requested  to  make  an  examination  of  him  as  a  possible 
subject  for  deportation.     This  dependent  was  26  days  in  the  institution. 

Case  70.  The  Committee's  investigator  interviewed  the  dependent  at  the  ad- 
dress given,  where  he  was  living  with  a  daughter  and  2  sons,  both  of  whom  were 
employed.  The  same  information  was  gathered  as  by  the  Examiner  of  the  De- 
partment, to  whom  the  sons  claimed  they  were  unable  to  pay.  At  the  time  of  the 
visit  of  the  Committee's  investigator  the  family  was  supporting  the  father  at  home, 
but  I  son  was  working  only  about  3  or  4  days  a  week.  The  Bureau  record  is  to 
the  effect  that  this  man  was  a  citizen,  whereas  upon  the  Home  record  for  this,  his 
sole  admission,  it  was  stated  that  he  was  not  a  citizen.  This  statement  was  also 
made  to  the  Committee's  investigator  by  the  dependent.  The  dependent  remained 
83  days  in  the  institution. 


ADMISSIONS   TO    CITY  HOMES  267 

Case  74.  The  Committee's  investigator  learned  from  i  of  the  daughters  whose 
address  was  given  on  the  Home  records  the  addresses  of  the  dependent's  2  sons. 
The  daughter  said  that  she  or  her  brothers  would  have  been  glad  to  support  their 
father  in  any  one  of  their  homes.  An  Examiner  of  the  Department  of  Public 
Charities  reported  that  the  children  could  not  be  located,  but  that  the  janitor  at  the 
address  visited  had  reported  that  they  were  well-to-do.  The  investigation  card  was 
turned  in  at  the  Bureau  for  another  Examiner  to  call  upon  the  daughter,  but  was 
filed  as  "Not  found."    This  dependent  remained  96  days  and  died  in  the  institution, 

Case  79.  The  brother-in-law's  address  (obtained  at  this  Home)  was  visited  by 
the  Committee's  investigator,  and  his  wife  made  the  statement  that  this  inmate  had 
a  bank  account  of  $200,  and  apparently  had  had  a  considerable  amount  of  money. 
No  action  was  taken  in  this  case  by  the  Bureau  except  to  approve  it.  No  other 
address  but  that  of  a  lodging  house  appeared  on  the  record  there. 

Case  86.  This  case  was  referred  to  the  Brooklyn  Bureau  of  Dependent  Adults, 
according  to  the  records  at  the  Manhattan  Bureau.  The  Home  record  showed  that 
the  dependent  was  an  alien.  No  record  could  be  found  of  any  request  to  the  State 
Board  of  Charities  for  investigation  of  this  case  for  possible  deportation. 

Case  93.  The  Committee's  investigator  discovered  that  this  dependent,  a  young 
man  of  18,  was  a  non-resident  of  New  York  City,  having  lived  in  the  City  only  5 
months.  This  case  had  been  reported  to  the  State  Board  of  Charities  from  Bellevue 
Hospital,  from  which  he  had  been  transferred.  The  address  at  the  Home  and  at 
the  Bureau  was  incorrect.  The  correct  address  was  learned  from  the  State  Board 
of  Charities,  where  it  was  said  that  the  dependent  was  to  be  returned  to  the  place 
of  his  legal  settlement. 

Case  98.  The  Committee's  investigator  learned  that  this  dependent  was  not 
a  citizen,  which  fact  also  appeared  on  the  Home  records  and  at  the  Bureau.  A  visit 
was  made  to  the  daughter's  address  by  an  Examiner  from  the  Department  and  the 
case  was  filed,  marked  "Daughter  will  call,"  as  the  last  entry.  No  record  could  be 
found  that  the  State  Board  of  Charities  had  been  requested  to  make  an  investiga- 
tion in  this  case  for  possible  deportation. 

Case  112.  The  address  of  the  friend  of  this  dependent  was  obtained  from 
this  Home,  and  of  that  of  his  brother-in-law  from  Bellevue  Hospital,  from  which 
place  he  had  been  transferred  to  this  Home.  The  Home  record  showed  this  de- 
poident  to  have  been  an  alien.  The  case  was  approved  at  the  Bureau  without  in- 
vestigation. No  addresses  appeared  on  the  history  card  there,  and  none  appeared 
to  have  been  secured  from  Bellevue  Hospital.  No  record  could  be  found  of  any 
request  made  to  the  State  Board  of  Charities  for  investigation  of  this  case  for 
possible  deportation. 

Case  122.  The  wife  of  this  dependent,  who  was  seen  at  the  address  given, 
said  that  he  was  in  receipt  of  a  pension  from  the  U.  S.  Government.  This  informa- 
tion was  also  received  by  the  Examiner  of  the  Department  of  Charities ;  never- 
theless, the  case  was  approved  for  dependence  in  the  City  Home.  (See  Section  80 
of  Article  6  of  the  Poor  Law  quoted  on  page  24.) 

Case  123.  This  dependent's  home  was  visited.  His  stepdaughter  stated  that 
his  children  had  given  him  $10  a  month  for  several  years.  The  fact  that  the  de- 
pendent was  an  alien  appeared  on  the  Home  records.  This  case  was  referred  to 
the  Brooklyn  Home,  but  was  not  investigated  by  the  Manhattan  Bureau  of  De- 
pendent Adults,  and  no  record  appeared  upon  the  history  card  of  any  report  from 
the  Brooklyn  Home.  This  dependent  remained  in  this  Home  for  51  days.  No  rec- 
ord was  found  that  the  case  had  been  referred  to  the  State  Board  of  Charities  for 
investigation  for  possible  deportation. 

Case  127.  The  Home  record  gave  only  a  lodging  house  address  for  this  in- 
mate, showing  a  residence  of  19  months  in  the  United  States,  without  naturalization. 
The  Bureau  record  is  to  the  effect  that  this  inmate  was  a  citizen  of  the  United 
States,  and  had  been  in  the  State  and  City  19  years.  The  case  was  approved  with- 
out investigation. 

Case  129.  The  address  given  for  the  wife  was  visited  and  her  new  address 
learned.  She  said  that  her  husband  had  been  taken  from  this  Home  by  their 
daughter  to  her  own  home.  The  wife  expressed  herself  as  willing  to  support  her 
husband  in  her  home.  The  Home  records  showed  this  dependent  to  have  been  an 
alien.     This   case  was  approved  without  investigation  at  the  Bureau.     No  record 


268  HOSPITAL    COMMITTEE 

was  found  that  this  case  was  referred  to  the  State  Board  of  Charities  for  investi- 
gation for  possible  deportation.  This  dependent  remained  in  the  Home  for  a  period 
of  107  days. 

Case  145.  This  dependent  was  admitted  to  this  Home  twice  during  the  month 
of  May,  1012,  according  to  the  records.  A  visit  to  his  address,  obtained  from  the 
Home,  led  to  an  interview  with  him  at  his  new  address,  where  he  was  working  for 
board  and  lodging.  He  said  that  his  wife  was  earning  sufficient  for  the  support  of 
herself  and  2  children.  No  investigation  was  made  in  this  case  by  the  Bureau. 
The  records  there  showed  he  was  not  a  citizen  and  upon  both  admissions  was 
referred  to  the  State  Board  of  Charities  for  investigation.  At  the  end  of  the  first 
6  days  he  was  discharged  by  the  order  of  the  Deputy  Superintendent  of  the  De- 
partment of  State  and  Alien  Poor  of  the  Board,  and  readmitted  on  the  same  day 
by  the  Bureau  of  Dependent  Adults.  Upon  the  second  stay  he  remained  for  a 
period  of  96  days. 

Case  177.  The  Committee's  investigator  found  this  man  to  have  5  sons  and  I 
daughter  employed,  and  his  landlord  said  that  I  son  was  quite  prosperous.  The 
dependent's  daughter  said  that  he  was  in  receipt  of  a  pension  for  service  in  the 
United  States  Navy.  The  Bureau  records  showed  that  the  children  of  this  man 
were  able  to  pay.  The  case  was  filed,  approved  temporarily,  pending  action  of  the 
Bureau  of  Domestic  Relations,  but  no  further  entry  appeared  upon  the  case.  No 
record  was  made  of  the  fact  that  he  had  served  in  the  United  States  Army.  At 
the  expiration  of  185  days  stay  this  dependent  was  still  in  this  Home. 

Case  183.  The  address  of  the  son  of  this  inmate  was  visited,  where  it  was 
discovered  that  he  had  moved  to  the  house  owned  by  him  at  Coney  Island.  The 
son  was  seen  at  his  place  of  employment  and  was  found  to  be  able  to  support  his 
father.  The  son's  wife  also  was  earning  an  income.  No  address  appeared  upon 
the  history  card  of  this  inmate  at  the  Bureau,  and  the  admission  was  approved  with- 
out investigation. 

Case  187.  This  inmate  was  admitted  without  giving  any  residence  address  for 
himself  or  friends.  The  Home  records  showed  that  he  was  an  alien.  No  record 
could  be  found  that  this  case  was  referred  to  the  State  Board  of  Charities  for  in- 
vestigation for  possible  deportation. 

Case  191^2.  This  dependent's  daughter  was  seen  at  the  address  obtained  from 
the  Home,  and  said  it  was  entirely  unnecessary  for  him  to  be  there,  as  his  children 
would  support  him.  She  requested  that  he  be  refused  admission  if  he  applied  again. 
The  history  of  this  inmate  at  the  Bureau  showed  that  he  was  referred  to  the  dis- 
pensary for  treatment  as  not  a  proper  hospital  case.  From  the  permit  stub,  how- 
ever, it  appeared  that  a  permit  was  issued  for  his  admission  to  the  Home  without 
investigation. 

Case  194.  This  dependent's  sister-in-law  was  seen  at  the  address  given  at  this 
Home  as  his  residence.  The  home  gave  every  indication  of  being  that  of  people 
in  prosperous  circumstances.  At  Bellevue  Hospital  it  was  learned  that  the  patient's 
expenses  had  been  paid  by  his  son.  This  dependent  was  admitted  without  investiga- 
tion. The  Bureau  records  showed  that  he  had  been  i  day  in  the  City,  and  the  in- 
stitution was  notified  to  have  papers  made  out  for  the  State  Board  of  Charities. 
The  dependent  was  finally  discharged  from  the  Home  to  his  relatives,  who  were 
willing  and  able  to  care  for  him. 

Case  2og.  The  Home  records  showed  the  dependent  to  have  been  an  alien. 
The  case  was  approved  at  the  Bureau  without  investigation  and  without  request  to 
the  State  Board  of  Charities  for  investigation  for  possible  deportation. 

Case  221.  The  Home  records  showed  this  dependent  to  have  been  an  alien. 
The  case  was  approved  at  the  Bureau  without  investigation,  and  without  request 
to  the  State  Board  for  investigation  for  possible  deportation. 

Case  230.  The  Home  records  showed  this  dependent  to  have  been  an  alien, 
which  fact  was  confirmed  in  an  interview  with  his  wife  and  himself  at  the  address 
given.  The  Bureau  history  showed  that  the  Examiner  called,  found  no  one  at  home, 
and  was  told  to  call  again.  The  card  was  filed  without  record  of  any  further  calls. 
No  record  could  be  found  that  this  case  had  been  referred  to  the  State  Board  of 
Charities  for  investigation  for  possible  deportation. 


ADMISSIONS   TO   CITY   HOMES  269 

Case  240.  The  Home  records  showed  this  inmate  to  have  been  an  alien.  The 
Bureau  history  card  gave  a  lodging  house  address  as  his  residence.  The  case  was 
not  investigated  by  the  Bureau  and  the  dependent  was  recorded  there  as  a  citizen. 
The  case  was  approved  for  dependence  in  the  City  Home. 

Case  244.  The  Home  records  showed  that  this  inmate  had  the  sum  of  $26o.cx) 
upon  his  person  and  that  he  had  been  in  the  City  only  2  days.  The  Bureau  records 
showed  that  the  case  was  not  investigated.  The  State  Board  of  Charities,  however, 
was  requested  to  investigate  this  case  for  possible  removal,  and  the  Home  was  in- 
structed to  collect  one  dollar  a  day. 

Case  253.  At  the  son's  address,  visited  by  the  Committee's  investigator,  it  was 
learned  from  the  janitor  that  the  son  and  wife  had  lived  here  and  had  paid  a 
substantial  rent,  and  seemed  to  be  in  very  comfortable  circumstances.  The  Ex- 
aminer of  the  IBureau  visited  only  the  inmate's  address  without  making  an  effort 
to  interview  the  children. 


CITY  HOME  FOR  THE  AGED  AND  INFIRM, 
BROOKLYN  DIVISION 

According  to  the  official  census  published  in  the  City  Record  the  total 
number  of  admissions  of  dependents  to  this  institution  in  the  year  191 1  was 
3,460,  of  which  number  2,482  were  males  and  978  females.  These  figures, 
however,  do  not  correspond  to  the  number  of  admissions  as  com.piled  from 
the  daily  census  book  in  the  Information  Office  of  this  Home,  which  shows 
the  toal  number  of  admissions  in  this  year  to  have  been  3,304,  or  156  less 
than  the  official  census.  Also,  upon  an  examination  of  the  alphabetical 
register  of  the  dependents  at  this  Home  it  was  found  that  the  entries  upon 
this  book  for  all  dependents  admitted  during  this  period  were  85  less  than 
the  number  of  admissions  entered  in  the  census  book,  and  241  less  than  the 
number  of  admissions  recorded  in  the  official  census.     (Table  XXI.) 

The  discrepancies  between  the  total  number  of  admissions  according 
to  the  census  book  and  according  to  the  official  census  lie  almost  entirely 
between  the  figures  entered  for  the  first  and  last  quarters  of  the  year, 
there  having  been  144  less  admissions  according  to  the  census  book 
during  these  two  quarters  than  according  to  the  official  census,  while  there 
were  only  12  less  in  the  second  and  third  quarters  of  the  year.  This  dis- 
crepancy was  found  to  lie  principally  in  the  records  of  admissions  of  the 
males  in  each  quarter  of  the  year,  the  number  of  females  according  to  the 
official  census  having  been  only  41  more  than  were  entered  upon  t'le  census 
book,  while  there  were  115  more  males  according  to  the  official  census  than 
the  census  book  showed.  As  will  be  noticed  in  the  same  table  in  the  second 
and  third  quarters  of  the  year  there  was  an  excess  of  only  i  female  on 
the  official  census  over  the  census  book. 

According  to  the  alphabetical  register  the  total  number  of  admissions 
for  the  year  191 1  was  3,219.  This  approximates  the  total  number  of  per- 
mits for  admission  issued  by  the  Bureau  of  Dependent  Adults  in  the  Deputy 
Commissioner's  Office,  Brooklyn,  and  of  transfer  permits  issued  in  the  name 
of  Kings  County  Hospital  and  Coney  Island  Hospital,  found  on  file  in  the 
institution.    These  permits  and  transfers  totaled  for  this  year  3,243. 

The  admissions  according  to  the  permits  and  transfers  on  file  were  24 
more  than  the  admissions  entered  upon  the  register;  61  less  than  the  admis- 
sions according  to  the  census  book;  and  217  less  than  the  admissions  ac- 
cording to  the  official  census. 

According  to  the  official  census  the  dependents  admitted  for  the  first  6 
months  of  1912  totaled  1,371,  of  whom  999  were  males  and  372  females 
(Table  XXII).  The  quarterly  totals  for  the  admissions  during  these  6 
months  exactly  correspond  to  the  summaries  of  the  daily  admissions  recorded 
in  the  census  book  kept  in  the  office  of  this  Home.  For  the  same  period,  how- 
ever, the  admissions  according  to  the  entries  upon  the  register  were  1,338, 
which  was  33  less  than  the  number  upon  the  census  book  and  in  the  official 
census.  Also,  there  were  found  only  1,319  permits,  which  were  less  than  the 
admissions  recorded  in  the  official  census. 

270 


ADMISSIONS   TO    CITY   HOMES  271 

Causes  of  Dependence 

No  record  of  the  causes  of  dependence  in  any  consecutive  or  tabulated 
form  could  be  discovered  in  this  Home.  There  was  space  for  this  informa- 
tion on  the  forms  in  the  book  for  histories  of  dependents  provided  for  by  the 
State  Board  of  Charities,  but  for  reasons  which  will  be  mentioned  later  it 
was  impracticable  to  make  any  deductions  from  these  sources. 

Avenues  of  Admission 

To  determine  the  various  avenues  of  admission  to  this  Home  the  permits 
and  transfer  slips  for  the  year  191 1  and  for  the  first  six  months  of  1912, 
also  the  daily  reports  of  admissions  transmitted  by  the  clerk  in  the  Informa- 
tion Office  to  the  Brooklyn  Bureau  of  Dependent  Adults,  and  the  entries 
made  upon  the  alphabetical  register  of  the  Home  were  inspected. 

These  dependents  were  found  to  have  been  admitted  through  the  follow- 
ing agencies : 

(a)  The  office  of  the  Deputy  Commissioner  of  Charities,  Brooklyn. 

(b)  Transfer  from  Kings  County  Hospital. 

(c)  Transfer  from  Coney  Island  Hospital. 

(d)  The  male  Supervising  Nurse  or  the  Matron  at  this  Home. 

(e)  The  Agent  of  the  State  Board  of  Charities. 

Authority  for  Admissions 

The  authority  for  admission  to  this  institution  might  be  supposed  to  rest 
with  the  Superintendent  of  the  Brooklyn  Bureau  of  Dependent  Adults, 
under  the  Second  Deputy  Commissioner  of  Charities,  as  that  would  seem 
to  be  one  of  the  functions  of  this  Superintendent — similar  authority  is 
vested  in  the  Superintendents  of  such  Bureaus  in  Manhattan  and  in  Rich- 
mond. As  a  matter  of  fact,  the  permits  issued  from  the  office  of  the  Deputy 
Commissioner  of  Charities,  Brooklyn,  are  not  over  the  name  of  the  Superin- 
tendent of  the  Bureau,  but  are  signed  with  the  name  of  a  clerk  in  his 
office.  A  large  number  of  these  permits  are  signed  in  blank  in  a  book  in 
which  they  are  bound,  and  are  afterward  filled  in,  as  occasion  demands, 
with  the  names  of  the  dependents  and  certain  other  information  regarding 
them.  The  dependents  presenting  such  permits  at  the  Home  are  recorded 
upon  the  alphabetical  register  as  having  been  admitted  by  "C  of  C,"  which 
is  interpreted  to  mean  by  the  Deputy  Commissioner  of  Charities, 
Brooklyn. 

Equal  authority  for  admission  to  this  Home  seems  to  be  vested  in  a 
representative  of  the  Superintendent  of  Kings  County  Hospital.  During 
the  year  191 1,  968,  or  29.8  per  cent.,  of  the  dependents,  by  actual  count  of 
the  slips,  were  admitted  to  this  Home  on  transfer  slips  over  the  name  of 
the  Superintendent  of  the  Hospital  (Table  XXI).  A  few  transfer  permits 
from  Coney  Island  Hospital,  7  in  all,  were  found  at  this  Home  that  had 
been  accepted  for  admission  of  dependents  in  the  year  191 1. 

The  inability  to  reconcile  the  differing  total  numbers  of  dependents  ad- 
mitted to  this  Home  shown  in  the  various  records  mentioned  above  was 
also  experienced  when  a  comparison  was  made  of  the  authority  for  the 
admissions  to  this  Home  as  represented  by  the  permits  and  transfers  fovmd 
at  the  Home,  and  of  the  authority  for  admissions  entered  for  the  same 


272  HOSPITAL    COMMITTEE 

period  in  the  alphabetical  register.  Although  the  total  number  of  per- 
mits and  transfers,  3,243,  approximates  3,219,  the  total  admissions  ac- 
cording to  the  register,  there  were  found  only  2,268  permits  from  the 
Deputy  Commissioner  of  Charities'  Office,  which  differs  from  the  2,326 
admissions  credited  to  the  same  authority  on  the  alphabetical  register 
(Table  XXI).  This  would  make  58  more  admissions  from  the  Deputy 
Commissioner's  Office,  according  to  the  register,  than  there  were  per- 
mits on  file.  There  were  108  less  admissions  from  Kings  County  Hos- 
pital, according  to  the  register,  than  there  were  permits,  the  total  num- 
ber of  transfers  from  that  institution  for  the  year  191 1  having  been 
860,  according  to  the  register,  whereas  968  transfer  slips  were  found  at 
the  Home.  Also,  2  transfers  from  Coney  Island  Hospital  were  not  entered 
upon  the  alphabetical  register  as  having  been  admitted  by  the  authority  of 
its  Superintendent,  for  there  were  7  transfer  permits  from  the  Hospital 
found  at  the  Home  and  only  5  transfers  were  entered  upon  the  register  for 
this  year.  This  discrepancy  in  the  two  records  of  the  authorizations  for 
admission  was  found  to  exist  not  only  in  the  yearly  totals,  but  also  between 
these  records  for  practically  every  month  in  the  year. 

As  no  record  of  the  sources  of  admissions  was  made  in  the  daily  census 
book  in  the  office  of  this  Home,  nor  in  the  quarterly  official  census  published 
in  the  City  Record,  no  comparison  along  this  line  could  be  made  with 
these. 

It  is  understood  that  the  attention  of  the  clerk  responsible  for  the 
register  of  this  Home  was  called  to  the  discrepancies  in  the  records  for 
the  month  of  December,  191 1.  However,  discrepancies  continued  for  the 
first  6  months  of  the  year  1912,  as  will  be  apparent  from  a  further  study  of 
Table  XXII.  It  will  be  seen  that  there  were  49  less  permits  from  the 
Deputy  Commissioner's  Office  on  file  for  these  6  months  than  there  were 
entries  on  the  alphabetical  register  of  admissions  by  his  authority,  the 
number  of  permits  having  been  869  and  the  entries  on  the  register  918. 
Also,  there  were  36  more  permits  found  for  transfers  from  Kings  County 
Hospital  than  there  were  dependents  entered  upon  the  register  at  the  Home, 
the  number  of  transfer  permits  having  been  448,  while  the  register  showed 
only  412  transfers  from  this  Hospital. 

Although  during  the  year  191 1  there  were  865  transfers  to  this  institution 
from  Kings  County  and  Coney  Island  Hospitals  according  to  the  alphabeti- 
cal register,  or  975  according  to  the  transfer  permits  found  at  the  Home, 
and  in  the  first  6  months  of  1912  there  were  414  such  transfers  according 
to  the  register,  or  450  according  to  the  transfer  permits,  this  does  not 
necessarily  mean  that  these  dependents  had  been  receiving  acute  hospital 
treatment  in  the  institutions  from  which  they  had  been  transferred.  On  the 
contrary,  during  the  last  quarter  of  1911  the  discharge  diagnosis  of  51,  or 
26  per  cent.,  of  the  193  dependents  transferred  from  Kings  County  Hos- 
pital to  this  Home  was  "non  curata."  This  diagnosis  has  been  said  to  mean 
that  these  individuals  had  not  been  in  need  of  hospital  treatment.  It  may 
be  noticed  that  although  only  193  dependents  appeared  on  the  books 
of  Kings  County  Hospital  as  having  been  transferred  from  that  institution 
to  this  Home  during  these  3  months,  the  alphabetical  register  of  the  Home 
indicated  that  209  dependents  had  been  received  from  this  Hospital  in  the 
same  period,  and  for  these  transfers  there  were  203  permits  found  at  the 
Home. 

In  other  words,  it  would  appear  that  10  permits  were  issued  in 
the  name  of  the  Superintendent  of  Kings  County  Hospital  for  the  admis- 


ADMISSIONS   TO   CITY  HOMES  273 

sion  to  the  Home  of  dependents  as  supposed  transfers  who  had  never  been 
patients  in  the  Hospital,  and  16  dependents  were  entered  upon  the  register 
as  transfers  from  the  Hospital  who  had  not  been  there. 

It  is  understood  that  liberty  is  given  to  the  supervising  male  nurse  in  this 
Home  after  the  office  of  the  Brooklyn  Bureau  is  closed,  and  further  permits 
cannot  be  issued  for  the  day,  to  admit  male  applicants  as  lodgers  that  in  his 
judgment  are  worthy.  It  is  also  understood  that  the  matron  in  charge  of 
the  female  wards  has  similar  liberty.  These  lodgers  are  supposed  to 
be  dismissed  the  following  morning  to  go  to  the  Bureau  for  a  permit  if  they 
desire  to  remain  longer  in  the  Home.  In  case  the  dependent  is  unable  to 
make  this  trip  to  the  Bureau  it  is  said  that  the  permit  is  asked  for  over  the 
telephone.  It  was  said  that  these  lodgers  were  counted  in  the  total  number 
of  daily  admissions,  but  not  entered  upon  the  register.  However,  ac- 
cording to  the  reports  made  to  the  State  Board  of  Charities  from  this  alms- 
house, the  number  of  lodgers  during  the  year  is  inconsiderable. 

A  study  was  made  of  all  the  admissions  for  the  month  of  May,  1912. 
According  to  the  census  book  these  were  240.  As,  however,  the  name  ap- 
peared upon  a  daily  census  slip  in  the  office  of  a  dependent  who  was 
said  to  have  been  a  lodger  during  this  month  but  not  to  have  been  included 
in  the  240  admissions,  241  was  accepted  as  the  number  of  admissions  for 
this  month.  The  names  for  these  241  admissions  were  secured  as  follows : 
232  were  taken  from  the  daily  reports  of  admissions,  copies  of  which  were 
found  in  the  office  of  the  Home ;  7  were  taken  which  did  not  appear  on  the 
admission  reports,  but  which  were  on  both  the  permits  or  the  transfer  slips, 
and  the  alphabetical  register;  to  these  were  added  i  name  from  a  permit 
which  appeared  neither  on  the  daily  admission  reports  nor  on  the  register ; 
and  the  name  of  the  lodger  mentioned  above,  from  a  daily  census  slip. 
The  last  name  was  supplied  by  the  clerk  in  the  Information  Office  when 
asked  to  explain  the  discrepancy  between  the  number  of  permits  and 
transfers,  and  the  number  claimed  to  have  been  admitted  during  that 
month.  The  other  names  not  on  the  daily  admission  reports  were  discovered 
in  a  comparison  of  the  different  records. 

To  authorize  these  241  admissions  there  were  found  at  the  Home  182 
permits  signed  by  a  clerk  in  the  Brooklyn  Bureau,  and  56  permits  for  the 
transfer  of  dependents  to  this  Home  from  Kings  County  Hospital  over  the 
name  of  its  Superintendent.  Inquiry  at  the  Hospital  brought  to  light  the 
fact  that  the  Hospital  had  no  record  of  8  of  these  dependents  having  been 
in  that  institution,  nor  of  their  having  been  sent  to  this  Home  with  these 
transfer  permits.  Also,  3  admissions  to  this  Home  in  this  month  came  in 
without  permits.  Two  of  these  were  entered  as  lodgers  on  the  daily 
admission  reports  but  were  not  entered  in  the  alphabetical  register,  and  i 
was  entered  on  a  daily  census  memorandum  in  the  office  but  not  on  the 
admission  report  nor  on  the  register.     (Table  XXIII.) 

The  permit  books  at  the  Brooklyn  Bureau  were  inspected  to  see  what 
record  existed  there  of  the  permits  found  at  this  Home  issued  over  the  name 
of  the  clerk  in  the  Bureau.  There  were  in  these  books  183  stubs  showing 
that  this  many  permits  had  been  issued  for  as  many  of  these  dependents  to 
enter  this  Home,  and  8  stubs  of  permits  for  the  admission  of  as  many  to 
Kings  County  Hospital.  Of  these  8  dependents  with  permits  for  the  Hos- 
pital, 6  were  admitted  at  this  Home  on  transfer  slips  from  the  Hospital 
bearing  the  same  date  as  these  permit  stubs ;  i  was  admitted  on  a  transfer 
slip  dated  for  the  day  after  the  date  of  the  permit  stub ;  and  the  other 
was  admitted  apparently  without  any  transfer  slip  10  days  after  the  date 


274  HOSPITAL   COMMITTEE 

on  the  permit  stub  and  entered  on  the  daily  reports  as  coming  from  the 
Hospital. 

From  the  permit  stubs  issued  for  admissions  to  the  Home  it  was  found 
that  in  2  cases  the  dependents  had  entered  the  Home  on  the  day  before  the 
date  on  the  stubs ;  in  2  cases  they  had  entered  6  and  9  days,  respectively, 
after  the  date  on  the  stubs ;  while  in  7  cases  the  admissions  were  on  the 
day  following  the  date  on  the  stub. 


Control  of  Admissions 

From  January  i,  1909,  to  August  i,  1912,  there  was  a  total  number  of 
977  discharges  of  dependents  from  this  Home  for  transfer  to  Farm  Colony. 
The  purpose  of  this  discharge  was  to  relieve  the  congestion  at  the  Home 
by  filling  vacancies  at  the  Colony.  The  success  of  this  measure,  however, 
was  interfered  with  by  the  readmission  of  a  number  of  these  same  depend- 
ents at  this  same  Home  (Summary  H  on  page  307,  and  Table  XXIV). 
These  977  discharges  represented  a  total  of  869  individuals,  427,  or  49 
per  cent.,  of  whom  left  Farm  Colony  otherwise  than  by  transfer  or  death, 
and  169,  or  19  per  cent.,  of  whom  were  readmitted  to  the  Home  after 
their  first  discharge  from  there  for  transfer  to  the  Colony. 

The  avenues  of  the  readmission  of  158  of  these  transfers  was  through 
the  Deputy  Commissioner  of  Charities'  Office,  Brooklyn,  and  of  11  by  trans- 
fer from  Kings  County  Hospital,  according  to  the  register  in  the  Home 
(Table  XXV).  Of  the  11  cases  readmitted  through  the  Hospital  the 
majority  had  either  made  only  a  very  brief  stay  there  or  had  not  even 
been  entered  on  their  records. 

After  a  varying  length  of  stay  in  the  Home,  and  after  22  of  the  num- 
ber had  been  allowed  to  pass  in  and  out  of  the  Home  on  permits  from  the 
Deputy  Commissioner's  Office  from  2  to  9  times  each,  82  of  these  readmitted 
dependents  were  discharged  a  second  time  from  the  Home  for  transfer  to 
Farm  Colony.  Of  the  87  not  so  discharged  11  were  allowed  to  remain  in 
the  Home  until  the  date  of  this  inquiry  in  August,  1912,  and  3  others  died 
there.    The  majority  of  the  remainder  left  the  Home  at  their  own  request. 

The  result  of  these  second  discharges  was  similar  to  that  which  attended 
the  initial  discharges.  Forty-six,  or  55.8  per  cent.,  left  the  Colony  other- 
wise than  by  transfer  or  death,  and  28,  or  34  per  cent.,  were  readmitted  to 
the  Home.  All  of  these  28,  according  to  the  record  at  the  Home,  were  re- 
admitted by  permit  from  the  Office  of  the  Deputy  Commissioner  of  Charities 
(Table  XXVI).  After  a  stay  of  diflferent  periods  in  the  Home,  and  in 
the  case  of  8  of  the  number  after  readmission  from  2  to  6  different  times 
by  permit  to  the  Home,  18  of  these  28  who  had  been  admitted  for  the  second 
time  were  again  discharged  for  transfer  to  the  Colony.  Of  this  number, 
II,  including  all  that  left  the  Colony  without  transfer  or  death,  were  re- 
admitted to  the  Home  for  the  third  time,  10  by  permit  from  the  Deputy 
Commissioner  of  Charities'  Office  and  i  from  Kings  County  Hospital.  Of 
these  II,  8  were  again  sent  to  the  Colony,  and  of  these,  5  again  left  the 
Colony  otherwise  than  by  transfer  or  death.  Two  of  these  8  were  read- 
mitted to  the  Home  by  permit  from  the  Deputy  Commissioner  of  Oiarities' 
Office  and  were  allowed  to  leave  there  at  their  own  volition.  (Table 
XXIV.) 

To  check  these  readmissions  and  the  readmission  of  dependents  who 
were  discharged  from  the  Home  for  refusing  to  accept  the  transfer  to 


ADMISSIONS   TO   CITY  HOMES  275 

Farm  Colony,  the  Second  Deputy  Commissioner  of  Charities  wrote  the 
following  letter: 

Brooklyn,  N.  Y.,  Oct.  7,  191 1. 
Mr.  M.  a.  McCaety, 

Relief  Clerk,  Bureau  of  Dependent  Adults, 
Brooklyn,  N.  Y. 
Dear  Sir : — 

It  has  been  brought  to  my  attention  that  the  inmates  and  patients  selected  at 
Kings  County  institutions  for  transfer  to  Farm  Colony  and  to  Metropolitan  Hospi- 
tal sometimes  refuse  to  go  and  take  their  discharge.  Therefore,  it  is  hereby  or- 
dered that  any  patient  who  is  selected  to  be  transferred  to  Farm  Colony  or  to 
Metropolitan  Hospital  shall  not  be  readmitted  to  any  public  institution  in  the 
Borough  of  Brooklyn,  but  should  be  referred  to  the  Bureau  of  Dependent  Adults, 
Borough  of  Manhattan,  foot  of  East  26th  Street,  where  permits  will  be  issued  for 
their  admission  into  institutions  in  Manhattan  or  Farm  Colony. 

This  rule  is  to  be  strictly  enforced  and  carried  into  effect  at  once. 

(Signed)   Thomas  L.  Fogarty, 

Second  Deputy  Commissioner. 

That  this  letter  had  very  little  effect  may  be  seen  from  the  fact  that  of 
the  total  number  of  270  readmissions  of  dependents  in  a  period  of  3  years 
and  7  months,  158,  or  58.5  per  cent.,  entered  the  Home  again  after  their  first 
discharge  for  transfer  to  the  Colony  within  a  period  of  11  months  after  the 
date  of  the  Deputy  Commissioner's  Letter  (List  II,  page  313).  Or,  to  express 
it  differently,  of  the  total  of  169  dependents  readmitted  to  the  Home  who 
had  I  or  more  times  been  discharged  for  transfer  to  the  Colony,  loi,  or 
59.7  per  cent.,  were  allowed  to  come  in  after  this  date.  All  of  these  de- 
pendents, with  the  exception  of  7  who  had  come  by  way  of  Kings  County 
Hospital,  were,  according  to  the  records  of  the  Home,  admitted  through 
the  office  of  the  Deputy  Commissioner  who  issued  the  letter. 

This  order  of  the  Deputy  Commissioner  was  no  more  effective  in  pre- 
venting the  readmission  of  those  who  had  been  discharged  from  the  Home 
for  refusing  to  be  transferred  to  Farm  Colony  than  in  keeping  out  those 
removed  for  this  transfer  (List  III,  on  page  316).  There  were,  according 
to  the  records,  178  individuals  discharged  for  such  refusal  in  the  same 
period,  from  January  i,  1909,  to  August  i,  1912  (Table  XXVII).  Of  these, 
47,  or  26  per  cent.,  were  readmitted  to  the  Home,  39  through  the  office 
of  the  Second  Deputy  Commissioner  of  Charities  and  8  by  transfer  from 
Kings  County  Hospital  (Table  XXVIII).  Only  6  of  these  readmitted 
dependents  had  their  first  stay  in  the  institution  after  this  readmission 
terminated  by  their  second  refusal  to  accept  a  transfer  to  the  Colony.  Three 
were  allowed  to  come  into  this  Home  through  the  Brooklyn  Bureau  from 
2  to  3  times  each,  and  were  finally  discharged  for  refusing  transfer  to 
Farm  Colony.  Of  these  47  readmissions  14,  or  29  per  cent.,  were  remaining 
in  the  Home  in  the  fall  of  1912,  and  as  many  more  had  been  allowed  to 
leave  the  Home  at  their  own  volition.    (Table  XXVIII.) 

Of  the  9  discharged  for  their  second  refusal  of  transfer  6  were  read- 
mitted to  the  Home  through  the  Deputy  Commissioner  of  Charities'  Office. 
Of  these,  3  left  by  their  own  choice  and  3  were  eventually  discharged  for 
the  third  time  for  refusing  to  go  to  Farm  Colony,  only  to  let  2  be  read- 
mitted again  through  the  Second  Deputy  Commissioner's  Office,  and  i 
through  Kings  County  Hospital.  One  of  these  last  2  absconded  from  the 
Home,  but  the  other  was  discharged  for  the  fifth  time  for  unwillingness  to 
go  to  the  Colony,  only  to  be  readmitted  again,  and  again  discharged  for  the 
same  reason,  and  finally  admitted  again  and  allowed  to  remain  in  the  Home. 

All  statements  made  with  regard  to  the  readmission  to  the  Home  of 


276  HOSPITAL   COMMITTEE 

dependents  discharged  for  refusing  transfer  to  the  Colony  cover  only  those 
readmissions  in  which  the  dependents  gave  the  same  names  and  sufficient 
other  data  to  make  possible  their  identification  as  having  been  admitted 
previously.  It  is  impossible  to  ascertain  how  many  cases  of  readmission 
there  were  in  which  the  dependents  gave  diflferent  names  and  so  escaped 
detection. 

With  the  lack  of  system  and  the  absence  of  records  in  the  Deputy  Com- 
missioner's office  it  would  have  been  difficult,  in  fact,  practically  impossible, 
except  in  a  limited  number  of  cases,  for  the  clerks  in  this  office  who  issued 
permits  to  prevent  such  readmissions.  These  clerks  would  have  had  to  de- 
pend upon  their  personal  recognition  of  an  applicant  for  readmission.  as 
no  effort  had  been  made  to  record  identifying  data  on  the  previous 
admission. 

In  some  of  the  cases  of  the  readmission  of  the  dependents  transferred 
to  Farm  Colony  no  record  could  be  found  at  Kings  County  Hospital  of  any 
stay  there,  although,  according  to  the  register  at  the  Home,  they  had  been 
admitted  on  transfer  slips  over  the  name  of  the  Superintendent  of  the 
Hospital.  In  the  cases  of  others  the  stay  at  the  Hospital  was  very  brief,  fre- 
quently only  over  night.  The  same  facts  were  true  of  the  readmissions  of 
the  dependents  discharged  from  the  Home  for  refusing  to  be  transferred  to 
the  Colony. 

History  Records 

At  the  Deputy  Commissioner's  office  no  record  whatever  was  kept  by 
the  clerks  of  the  dependents  to  whom  they  issued  permits  for  admission  to 
the  Home,  unless  the  stubs  of  the  permits  be  called  records,  and  there  was 
no  documentary  evidence  of  any  examination  of  the  dependents  to  determine 
the  propriety  of  their  admission.  The  partial  protection  against  improper 
admissions  that  is  given  the  other  almshouses  is  not  apparent  in  connection 
with  this  institution. 

The  records  of  inmates  at  this  Home  were  less  complete  and  less 
serviceable  than  in  either  of  the  other  almshouses.  No  effort  appeared 
to  have  been  made  to  look  up  previous  admissions  of  the  dependents  and  to 
connect  the  meager  information  secured  on  different  occasions.  The  only 
history  record  of  the  institution  in  the  Information  Office  that  is  of  any 
practical  value  is  the  alphabetical  register;  but  this  contains  no  social  or 
financial  history  of  the  dependent.  It  does  not  show  whether  he  or  she 
is  an  alien  or  a  citizen,  and  does  not  give  the  length  of  residence  in  New 
York  City.  In  other  words,  there  is  no  evidence  at  this  Home  as  to  whether 
or  not  the  dependent  is  properly  a  charge  upon  the  City  of  New  York. 

The  names  in  this  alphabetical  register  have  been  allowed  to  so  far 
overrun  the  pages  apportioned  to  particular  letters  of  the  alphabet  that  en- 
tries have  been  made  of  the  surnames  of  dependents  beginning  with  these 
letters  in  a  number  of  places  throughout  the  book,  wherever  there  were 
vacant  pages  for  names  beginning  with  other  letters.  When  the  books 
were  first  examined  it  was  possible  to  locate  these  various  entries  only  by 
reference  to  the  clerk  who  kept  the  book,  as  in  a  majority  of  cases  when 
the  pages  allotted  to  a  name  beginning  with  a  certain  letter  had  been  filled 
there  was  no  reference  to  the  page  or  pages  where  the  remainder  of  the 
names  beginning  with  the  same  letter  could  be  found. 

This  Home  was  designated  as  a  State  Almshouse  for  the  reception  of 
State  Poor,  after  a  contract  had  been  drawn  up  between  the  State  Board 
of  Charities  and  the  City  in  the  year  1875  ^oi"  the  payment  for  the  mainte- 


ADMISSIONS   TO   CITY  HOMES  277 

nance  of  the  State  Poor,  and  formerly  received  a  large  number  of  people 
committed  as  State  charges.  At  present,  however,  there  is  no  State  register 
of  State  Poor  kept  of  cases  at  this  Home,  such  as  is  kept  at  the  Manhattan 
Home,  also  a  State  Almshouse,  and  the  number  of  State  Poor  received  here 
would  seem  to  be  very  small. 

A  history  of  all  inmates  in  the  City  Home  must  be  kept,  in  accordance 
with  Article  9,  Section  142,  of  the  Poor  Law  of  New  York  State,  which 
reads  as  follows : 

In  addition  to  the  general  register  of  the  inmates  of  the  various  almshouses 
there  shall  be  kept  a  record  of  the  sex,  age,  birthplace,  birth  of  parents,  education, 
habits,  occupation,  condition  of  ancestors  and  family  relations,  and  cause  of  de- 
pendence of  each  person  at  the  time  of  admission,  with  such  other  facts  and  particu- 
lars in  relation  thereto  as  may  be  required  by  the  State  Board  of  Charities,  upon 
forms  prescribed  and  furnished  by  such  board.  Superintendents  and  overseers  of 
the  poor,  and  other  officers  charged  with  the  relief  and  support  of  poor  persons, 
shall  furnish  to  the  keepers,  or  other  officers  in  charge  of  such  almshouses,  as  full 
information  as  practicable  in  relation  to  each  person  sent  or  brought  by  them  to 
such  almshouse,  and  such  keepers  or  other  officers  shall  record  the  information 
ascertained  at  the  time  of  the  admission  of  such  person,  on  the  forms  so  furnished. 
All  such  records  shall  be  preserved  in  such  almshouses,  and  the  keepers  and  other 
officers  in  charge  thereof  shall  make  copies  of  the  same  on  the  first  day  of  each 
month,  and  immediately  forward  such  copies  to  the  State  Board  of  Charities. 

This  section  of  the  law  has  been  frequently  disregarded  in  this  Home, 
for  of  the  241  admissions  of  dependents  during  the  month  of  May,  1912, 
only  106  forms  in  the  history  book  furnished  by  the  State  Board  of  Chari- 
ties were  filled  in  in  accordance  with  this  requirement.  As  4  of  these  106 
dependents  had  been  previously  admitted  in  this  month,  these  106  forms 
would  correspond  to  no  admissions  during  this  time.  An  attempted  ex- 
planation of  the  difference  between  this  number  and  the  total  number  of 
admissions  was  that  the  forms  had  been  filled  in  in  this  same  book  for 
the  dependents  at  their  previous  admissions.  As,  however,  there  had  been 
no  effort  made  at  this  institution  to  keep  in  any  one  place  the  different  ad- 
missions of  the  same  individual,  as  had  been  done  at  the  Manhattan  Home, 
it  was  necessary  to  make  a  search  of  the  alphabetical  register  to  ascertain 
what,  if  any,  entries  of  previous  admissions  had  been  made  for  the  de- 
pendents entering  this  Home  in  this  month.  As  this  necessitated  looking 
through  all  the  entries  under  one  letter  for  each  name  beginning  with  a 
particular  letter  of  the  alphabet,  it  was  evident  that,  except  in  a  limited  num- 
ber of  cases,  these  State  history  records  were  useless  for  any  ready  refer- 
ence. In  fact,  it  could  not  be  discovered  that  anyone  had  ever  been 
known  to  make  use  of  them.  Examining  the  State  book  for  all  forms 
corresponding  to  the  dates  of  the  former  admissions  of  the  dependents 
entering  the  institution  in  May,  37  more  forms  for  these  dependents  were 
found.  In  the  remaining  94  admissions  in  this  month,  or  39  per  cent,  of  the 
total,  no  forms  filled  in  as  called  for  by  the  law  were  discovered. 

In  the  case  of  almost  none  of  the  147  admissions  for  which  forms  were 
found  were  the  latter  completely  filled  in  with  the  information  called  for. 
Such  important  information  as  the  citizenship  of  a  dependent  of  alien 
birth  was  entered  in  almost  none  of  the  forms.  This  omission  seriously  in- 
terfered with  the  classification  of  the  dependents  in  this  Home  (Table 
XXXI),  contrasting  it  very  strongly  in  the  proportion  of  dependent  aliens 
found  in  the  Manhattan  Home  (Tables  XV  and  XVIII)  and  Farm  Colony 
(Tables  XLI  and  XLIV). 

Upon  the  bedside  cards  of  the  dependents  there  was  a  space  provided 


278  HOSPITAL  COMMITTEE 

for  information  as  to  length  of  residence  in  the  City,  and  this  information 
was  supposed  to  be  entered  upon  the  card  when  made  out  upon  the  admission 
of  the  dependent.  An  examination  of  a  number  of  these  cards  showed  that 
this  particular  information  was  infrequently  placed  upon  them.  This 
Home  had  no  card  census  of  dependents  in  the  Information  Office  for  ready 
reference,  showing  their  location  in  the  Home. 

The  addresses  on  record  at  this  Home  for  the  residences  of  dependents, 
and  of  the  relatives  or  friends  who  were  to  be  communicated  with  in  case 
of  necessity,  did  not  seem  to  be  up  to  date.  A  condition  prevailed  here 
similar  to  that  already  dwelt  upon  in  connection  with  the  other  City  Home. 
By  actual  investigation  of  236  addresses  given  as  the  residences  of  the 
dependents  admitted  in  May,  19 12,  only  76,  or  32.2  per  cent.,  proved  to 
have  been  the  actual  addresses  of  the  dependents  just  prior  to  admission. 
At  58,  or  24.6  per  cent.,  of  the  addresses  the  dependents  were  not  known; 
22,  or  9.3  per  cent.,  were  addresses  the  dependents  had  left  at  a  considerable 
time  prior  to  admission  to  the  institution ;  and  22,  or  9.3  per  cent.,  were 
addresses  that  were  not  residential.  The  lodging  house  addresses  given  as 
residences  numbered  24,  or  10.2  per  cent.  There  were  4,  or  1.7  per  cent., 
addresses  that  were  not  sufficiently  explicit  for  investigation,  while  30,  or 
12.7  per  cent.,  of  the  admissions  had  no  addresses  upon  the  records  of  this 
month  for  any  residence  outside  of  the  institution.     (Table  XXIX.) 

There  were  also  investigated  194  addresses  of  relatives  and  friends  found 
on  the  same  records.  Of  these,  122,  or  62.9  per  cent.,  were  found  to  have 
been  the  residences  for  the  names  given,  while  36,  or  18.6  per  cent.,  were 
addresses  where  the  friends  or  relatives  were  unknown.  Six,  or  3.1  per  cent., 
were  addresses  that  had  been  left  a  considerable  time  before  the  admission 
of  the  dependents  to  the  institution.  There  were  also  13,  or  6.7  per  cent., 
addresses  that  were  not  residential ;  9,  or  4.6  per  cent.,  were  not  specific 
enough  to  permit  of  investigation;  6,  or  3.1  per  cent.,  were  outside  of 
the  City;  and  2,  or  i  per  cent.,  were  lodging  house  addresses.  During  this 
month  there  were  36  admissions  to  the  Home  of  dependents  who  did  not 
give  the  name  and  residence  of  any  friend  or  relative.    (Table  XXX.) 

Character  of  Dependents 

Section  663  of  the  Charter  of  the  City  of  New  York,  describing  the  duty 
of  the  Commissioner  of  Charities  to  investigate  the  circumstances  of  every 
person  admitted  to  the  institutions  under  his  charge,  and  the  near  relatives  of 
every  such  person,  has  already  been  quoted  in  part  in  connection  with  the 
section  of  this  Report  dealing  with  the  Manhattan  Division  of  the  City 
Home,  and  can  be  found  by  reference  to  page  22. 

All  of  the  admissions  to  this  Home  in  May,  1912,  according  to  the  vari- 
ous records  at  the  Home,  numbered  241,  and  these  were  investigated.  In 
114  cases,  or  47.3  per  cent,  the  investigators  were  unable  to  obtain  sufficient 
information  about  the  dependents  to  allow  of  their  classification  as  to  the 
propriety  of  their  dependence  upon  the  City.  This  inability  came  from  the 
following  causes: 

The  addresses  found  at  the  Home  were  insuiScient  in 10  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 78      " 

The  addresses  given  were  too  old  in 12      " 

Sufficiently  complete  histories  could  not  be  secured  in 14      " 

Total 114  Cases 


ADMISSIONS   TO    CITY   HOMES  279 

(a)  Classification  of  Dependents 

The  remaining  127  cases  were  as  follows : 
Dependents  who  seemed  to  have  had  a  legitimate  claim  upon  the  City's 

support 88,  or  69,3% 

Dependents  who  were  aliens 4,   "     3.1% 

Dependents  who  did  not  have  a  legal  settlement  in  New  York  City  ....       1,   "       .8% 
Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 

maintenance 16,   "  12.6% 

Dependents  who  were  personally  able  to  pay  for  their  maintenance.  ...       2,   "     1.6% 
Dependents  who  were  wives  or  children  of  men  who  had  served  in  the 

U.  S.  Army  or  Navy 1,   "        .8% 

Dependents  who  had  relatives  not  legally  responsible  but  able  to  pay  for 

their  maintenance 2,   "     1.6% 

Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their 

own  homes 9,   "     7.1% 

Dependents  who  were  able  to  work  to  earn  their  own  support 4,   "     3.1% 

Total 127,  or  100.0% 

Accepting  as  correct  the  statement  of  the  clerk  in  charge  of  the  records 
at  this  Home  that  where  no  information  was  entered  upon  the  record 
regarding  the  naturahzation  of  an  aHen  the  dependent  had  not  been  natural- 
ized, the  records  of  the  Home  showed  that  there  were  99  aliens  admitted 
during  this  month.  This  number,  however,  has  not  been  taken  into  consider- 
ation in  the  calculation  of  the  following  estimates  of  expense. 

(b)  Estimate  of  Expense 

An  estimate  was  made  of  the  expense  of  the  dependents  having  these  127 
admissions,  based  upon  the  number  of  days  each  had  been  in  the  institution 
and  the  average  of  the  daily  expense  for  a  dependent  as  given  in  the  Annual 
Reports  of  the  Department  of  Public  Charities  for  this  Home  for  the  last 
5  years.    These  dependents  were  segregated  into  the  following  groups: 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 
maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 
The  dependents  in  Group  I  remained  in  this  Home,  after  their  various 
admissions,  for  a  total  of  2,461  days,  at  an  estimated  expense  of  $766.00. 
Had  the  99  admissions  of  aliens  during  this  month  been  counted,  which 
would  have  been  the  correct  number  if  all  those  dependents  of  alien  birth 
not  entered  on  the  State  history  books  of  this  Home  as  having  become 
naturalized  had  been  included  in  this  estimate  as  aliens  instead  of  only  the 
4  aliens  that  were  actually  included,  the  estimated  expense  for  this  group 
would  have  been  much  larger. 

Group  n. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 
Dependents  who  were  wives  or  children  of  men  who  had  served  in  the 
U.  S.  Army  or  Navy. 
The  dependents  in  Group  H  remained  in  this  Home  for  a  period  of 
143  days,  at  an  estimated  expense  of  $42.77. 

Group  HI. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support 
but  able  to  pay  for  their  maintenance. 


28o  HOSPITAL   COMMITTEE 

Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their 

own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

The  dependents  in  Group  III  remained  in  this  Home,  after  their  various 
admissions,  for  a  total  of  2,362  days,  at  an  estimated  expense  of  $706.47. 

The  total  estimated  expense  to  the  City  for  merely  the  maintenance  of 
the  dependents  in  these  three  groups  was  $1,515.24. 

Accepting  the  proportion  of  the  different  classes  of  dependents  in  the 
groups  above,  which  included  only  the  127  admissions  for  which  the  in- 
vestigators gathered  sufficient  information  to  permit  of  their  classification, 
for  the  total  of  241  admissions  in  the  month,  the  estimated  cost  by  groups 
of  these  dependents  admitted  during  May,  1912,  would  have  been  as  follows : 

Group     I $1,619.44 

Group    II 90.42 

Group  III 1,493.59 

Total $3,203.45 

(c)  United  States  Soldiers  and  Their  Families 

Section  80  of  Article  6  of  the  Poor  Law  of  the  State  of  New  York, 
already  quoted  in  the  section  of  this  Report  dealing  with  the  Manhattan 
Division  of  the  City  Home,  provides  as  follows : 

No  poor  or  indigent  soldier,  sailor  or  marine  who  has  served  in  the  military 
or  naval  service  of  the  United  States,  nor  his  family,  nor  the  families  of  any  who 
may  be  deceased,  shall  be  sent  to  any  almshouse,  but  shall  be  relieved  and  provided 
for  at  their  homes  in  the  city  or  town  where  they  may  reside,  so  far  as  practicable, 
provided  such  soldier,  sailor  or  marine,  or  the  families  of  those  deceased,  are,  and 
have  been,  residents  of  the  State  for  one  year.     .     .     . 

It  was  in  disregard  of  this  section  that  the  widow  of  a  soldier  in  the 
United  States  Army  was  admitted  to  this  Home  in  this  month  of  May. 

(d)  Removal  of  Aliens  and  Non-Residents 

At  the  office  of  the  Deputy  Commissioner  of  Charities,  Brooklyn,  a  book 
is  kept  containing  duplicates  of  the  forms  filled  out  in  requesting  the  State 
Board  of  Charities  to  remove  aliens  and  non-residents  who  had  been  found 
to  be  public  charges  in  Brooklyn  and  in  Queens  County.  No  record  was 
found  at  this  office  of  any  request  having  been  made  to  the  State  Board  of 
Charities  for  the  removal  of  aliens  or  non-residents  from  this  Home  in  con- 
nection with  their  admissions  during  the  month  of  May,  1912,  although 
over  100  of  the  admissions  were  said  to  have  been  of  aliens.  The  authority 
given  by  law  to  the  State  Board  of  Charities  to  make  these  removals  has 
been  quoted  in  this  Report  on  page  265. 

The  monthly  reports  of  the  State  Board  of  Charities  of  removals  from 
the  institutions  of  the  City  of  New  York  do  not  show  that  any  aliens  or  non- 
residents were  removed  from  this  Home  during  this  month. 

(e)  Comparison  of  Findings 

As  no  investigations  had  been  made  by  the  Brooklyn  Bureau  of  Depend- 
ent Adults  of  any  of  the  dependents  admitted  to  this  Home,  there  were 
no  findings  of  the  Examiners  of  Charitable  Institutions  of  the  Depart- 
ment of  Public  Charities  with  which  the  findings  of  the  investigators  of  the 
Committee  could  be  compared. 


CITY  FARM  COLONY 

During  the  last  6  months  of  the  year  191 1  there  were  758  admissions 
of  dependents  to  the  Colony,  according  to  the  official  census  published  in 
the  City  Record.  This  does  not  correspond  to  the  entries  upon  the  records 
at  the  Colony,  which  showed  only  741  admissions  in  this  period.  The  latter 
figure  is,  therefore,  accepted  as  correct.  During  the  first  6  months  of  19 12 
there  were  570  admissions.  During  the  12  months  from  July  i,  191 1,  to 
June  30,  1912,  the  total  admissions  were  1,311.  Of  these,  366  (Table 
XXXIV)  were  recorded  as  having  come  from  the  Borough  of  Manhattan, 
apart  from  262  from  the  Manhattan  City  Home;  3  from  Metropolitan 
Hospital ;  3  from  City  Hospital ;  40  from  Municipal  Lodging  House ;  and  2 
from  Randalls  Island,  making  676,  or  51.7  per  cent,  of  the  total,  who  came 
from  the  Borough  of  Manhattan. 

From  the  Borough  of  Brooklyn,  there  were  420  from  the  Brooklyn  City 
Home;  26  marked  Brooklyn;  and  i  from  Raymond  Street  Hospital,  mak- 
ing a  total  of  447,  or  34.1  per  cent.  There  were  118  admitted  from  the 
Borough  of  Richmond,  apart  from  10  from  S.  R.  Smith  Infirmary,  Staten 
Island;  20  for  observation  as  to  their  sanity;  i  from  the  House  of  Divine 
Providence;  16  reentered  on  the  books  to  correct  the  previous  entries  of 
their  discharge;  2  admitted  from  the  employees  at  the  Colony;  and  21  ad- 
mitted by  the  order  of  the  Superintendent  of  the  Colony,  making  a  total  of 
188,  or  14.2  per  cent.,  from  the  Borough  of  Richmond.  Of  the  total  of 
1,311  inmates,  1,200  were  males  and  iii  were  females. 

Causes  of  Dependence 

According  to  the  tabulation  in  Table  XXXV  the  reasons  governing  the 
admission  of  dependents  recorded  at  the  Colony  were  as  follows :  508,  or 
45  per  cent.,  dependents  were  admitted  in  the  11  months  from  July  i,  191 1, 
to  May  31,  1912,  because  they  were  out  of  work;  189,  or  16.8  per  cent., 
because  of  sickness;  174,  or  15.4  per  cent.,  because  of  old  age;  11,  or  i  per 
cent.,  were  epileptics;  42,  or  3.7  per  cent.,  were  admitted  as  insane;  11,  or  i 
per  cent.,  as  suspected  insane;  193,  or  17.1  per  cent.,  were  crippled.  The 
causes  for  the  admission  of  the  183  dependents  who  entered  in  June,  1912, 
had  not  been  tabulated  at  this  institution. 

Avenues  of  Admission 

A  study  was  made  of  all  dependents  admitted  to  the  Colony  during  the 
month  of  May,  1912,  numbering  98,  and  dependents  admitted  during  the 
month  of  December,  191 1,  numbering  145.  These  dependents  were  found 
to  have  been  admitted  to  this  institution  through  the  following  agencies : 

(a)  The  Bureau  of  Dependent  Adults,  Manhattan. 

(b)  The  Bureau  of  Dependent  Adults,  Brooklyn. 

(c)  The  Bureau  of  Dependent  Adults,   Richmond. 

(d)  Transfer  from  New  York  City  Home  for  the  Aged  and  Infirm, 

Manhattan  Division. 

281 


282  HOSPITAL   COMMITTEE 

(e)  Transfer  from  New  York  City  Home  for  the  Aged  and  Infirm, 

Brooklyn  Division. 

(f)  Transfer    from   Metropolitan   Hospital. 

(g)  Transfer  from  City  Hospital. 

(h)   Transfer  from  Municipal  Lodging  House, 
(i)   Transfer  from  S.  R.  Smith  Infirmary,  Staten  Island, 
(j)   Transfer  from  House  of  Divine  Providence, 
(k)   Order  of  the  Superintendent  of  the  Colony. 
(1)   Commitment  to  the  Psychopathic  Ward  of  the  Colony  for  obser- 
vation as  to  sanity. 

Seventy-six,  or  31.2  per  cent,  of  the  dependents  admitted  in  these 
months,  came  through  the  Manhattan  Bureau  (Table  XXXIV).  The  next 
largest  number  vi^as  65,  or  26.8  per  cent.,  transferred  from  the  Brooklyn 
Home.  The  next  largest  number  was  35,  or  14.4  per  cent.,  transferred 
from  Municipal  Lodging  House.  The  number  admitted  through  the  Bu- 
reau of  Dependent  Adults,  Richmond,  was  21,  or  8.7  per  cent.;  the  Man- 
hattan Home  transferred  21,  or  8.7  per  cent.;  4,  or  1.6  per  cent.,  were 
designated  only  as  from  Brooklyn ;  7,  or  2.9  per  cent.,  were  admitted 
for  observation  as  to  their  sanity;  3,  or  1.2  per  cent,  came  from  S.  R.  Smith 
Infirmary;  2,  or  0.8  per  cent.,  were  reentered  on  the  books  to  correct  the 
census ;  6,  or  2.5  per  cent.,  were  allowed  admission  by  the  order  of  the 
Superintendent;  2,  or  0.8  per  cent.,  came  from  Metropolitan  Hospital; 
and  I,  or  0.4  per  cent,  from  House  of  Divine  Providence,  S.  I. 

Authority  for  Admissions 

The  authority  for  admission  to  the  Colony  is  divided  between  the  Super- 
intendent of  the  Manhattan  Bureau  and  the  Superintendent  of  the  Richmond 
Bureau.  Dependents  admitted  by  transfer  from  the  Brooklyn  Home  are 
accompanied  by  permits  from  the  office  of  the  Second  Deputy  Commis- 
sioner of  Charities,  in  Brooklyn,  but  applications  for  these  transfers  are  un- 
derstood to  be  made  from  the  Brooklyn  Home  to  the  Superintendent  of  the 
Manhattan  Bureau,  and  such  transfers  are  supposed  to  be  made  only  with 
his  authority  and  upon  the  approval  on  medical  grounds,  or  after  actual 
medical  inspection  of  the  dependents,  by  the  General  Inspector  of  the 
Department.  As  the  Colony  has  had  attached  to  it  a  Psychopathic  Ward  for 
the  observation  of  the  alleged  or  suspected  insane,  such  cases  are  also 
received  through  commitment  by  magistrates.  Records  of  such  commit- 
ments, however,  are  kept  in  the  Richmond  Bureau. 

There  should,  therefore,  be  a  permit  from  one  of  the  three  Bureaus  of 
Dependent  Adults  or  commitment  papers  from  a  magistrate  to  accompany 
every  dependent  admitted. 

For  the  98  admissions  in  the  month  of  May,  1912,  there  were  found 
at  the  Colony  37  permits  from  the  Manhattan  Bureau  of  Dependent  Adults, 
in  which  were  included  the  permits  for  the  transfer  of  15  dependents  from 
the  Manhattan  Home.  There  were  also  17  permits  for  the  transfer  of 
dependents  from  the  same  City  Home  to  the  Colony,  and  2  for  transfer  from 
Metropolitan  Hospital,  making  a  total  of  56  permits  for  the  admission  of 
dependents  from  Manhattan.  For  the  15  dependents  admitted  from  Brook- 
lyn in  this  month  there  were  found  the  corresponding  number  of  permits. 
The  same  is  true  for  the  11  dependents  admitted  through  the  Bureau  of  Rich- 


ADMISSIONS   TO   CITY  HOMES  283 

mond.  There  were  7  dependents  committed  to  the  Psychopathic  Ward  by 
magistrates,  with  the  authorization  for  each  on  file  at  the  Colony. 

For  the  other  9  dependents  admitted  in  this  month  there  were  no  permits 
or  papers  authorizing  their  admission  on  file  at  the  Colony.  These  were  as 
follows :  I  for  observation  as  to  sanity ;  i  admission  from  House  of 
Divine  Providence,  Staten  Island;  2  admissions  of  former  inmates  of 
Farm  Colony;  i  admission  of  a  former  inmate  of  Municipal  Lodging 
House;  i  admission  of  a  recent  inmate  of  some  institution  on  Blackwell's 
Island  which  was  not  specified;  also,  3  entries  of  inmates  as  having  been 
admitted  in  this  month  who,  according  to  the  records,  had  been  erroneously 
entered  as  discharged  in  the  months  of  October,  191 1,  and  March,  1912, 
respectively,  the  error  in  making  the  discharge  entries  having  apparently 
only  been  discovered  in  the  month  of  May.     (Table  XXXVI.) 

The  permits  counted  do  not  correspond  to  the  entries  upon  the  books  of 
the  Colony,  which  show  that  there  were  58  admissions  from  the  Manhattan 
Bureau,  the  Manhattan  Home,  and  Metropolitan  Hospital.  The  1 1  shown  on 
the  books  as  admitted  through  the  Richmond  Bureau,  and  the  15  as  coming 
from  Brooklyn,  with  the  7  suspected  of  insanity,  have  corresponding  au- 
thorizations for  their  admission.  According  to  the  books  there  were  6  re- 
admissions  in  this  month  by  the  order  of  the  Superintendent,  who  would 
seem  in  this  case  to  have  exercised  some  of  the  functions  of  a  Superintendent 
of  a  Bureau  of  Dependent  Adults. 

The  books  at  the  Manhattan  Bureau  containing  the  stubs  of  the  permits 
for  the  admission  of  dependents  to  the  various  institutions  were  examined 
to  ascertain  what  record  there  was  at  this  place  of  the  authorization  for 
the  admissions  to  the  Colony  in  the  months  of  December,  191 1,  and  May, 
1912.  It  was  found  that  there  were  only  34  stubs  of  permits  at  the  Bureau 
for  the  41  admissions  made  to  the  Colony  from  this  Bureau  and  from  the 
City  Home  during  December,  according  to  the  records  on  the  books  at  the 
Colony.  No  permit  stubs  nor  other  records  were  discovered  at  the  Bureau 
authorizing  the  transfer  of  the  35  dependents  that  were  sent  from  Municipal 
Lodging  House  in  December  and  were  admitted  to  the  Colony  with  a  letter 
from  the  Superintendent  of  the  Lodging  House  to  the  Superintendent  of 
the  Colony  stating  that  he  was  sending  these  dependents  "as  requested." 
In  the  month  of  May,  1912,  there  were  only  56  permit  stubs  found  for  the 
58  admissions  from  Manhattan. 

Two  dependents  during  this  month  of  May  came  into  the  institution  6 
days  after  the  date  of  the  issuance  of  the  permits  for  admission.  These 
were  Brooklyn  residents  admitted  to  one  of  the  cottages.  Two  dependents 
transferred  from  Metropolitan  Hospital  were  admitted  3  days  after  the 
permits  were  issued,  and  17  dependents  transferred  from  the  Manhattan 
Home  were  admitted  on  the  day  preceding  the  date  of  the  permits,  while 
another  dependent  transferred  from  the  same  institution  was  admitted  3 
days  before  the  date  of  his  permit. 

At  the  Brooklyn  Bureau  only  46  permit  stubs  could  be  found  for  the 
54  transfers  from  this  Bureau  and  from  the  Brooklyn  Home  in  the  month  of 
December,  1911.  For  15  similar  transfers  in  the  month  of  May,  1912,  there 
were  found  only  11  permit  stubs. 

For  the  10  dependents  entered  on  the  books  of  the  Colony  as  admitted 
through  the  Richmond  Bureau  in  December,  1911,  there  were  8  permit 
stubs  found  at  this  Bureau.  For  11  similarly  entered  in  May,  1912,  there 
were  10  permit  stubs  found  and  record  of  i  commitment. 

There  was  admitted  to  the  Colony  in  the  month  of  December,  191 1,  I 


284  HOSPITAL   COMMITTEE 

dependent  presenting  a  permit  bearing  the  name  of  the  Superintendent  of 
the  Manhattan  Bureau  for  which  no  stub  could  be  located  at  this  Bureau. 
According  to  the  record,  this  dependent  had  no  home.  His  nearest  relative, 
however,  was  entered  as  a  resident  of  New  Jersey,  and  this  dependent  had 
been  naturalized  in  that  State.  There  were  2  other  dependents  admitted  in 
this  month  who  gave  Blackwell's  Island  only  as  their  address  for  whom  no 
permit  stub  could  be  found  at  the  Manhattan  Bureau,  but  whom  the  Colony 
records  showed  to  have  been  previous  inmates  of  the  Colony.  Another 
dependent  from  Manhattan,  a  woman,  whose  husband  was  at  the  Colony, 
according  to  their  records,  was  admitted  to  this  institution  in  December,  but 
no  permit  stub  could  be  found  for  her  at  this  Bureau.  A  former  inmate  on 
Blackwell's  Island,  with  residence  in  Manhattan,  had  no  permit  stub  at  the 
Manhattan  Bureau  for  his  admission,  and  another  dependent  with  a  Man- 
hattan address  was  entered  upon  the  records  of  the  admissions  in  December 
to  correct  an  entry  as  an  absconder  in  the  preceding  month. 

There  were  7  entries  of  admissions  in  this  month  of  dependents  for 
whom  Brooklyn  addresses  were  given,  but  for  none  of  whom  was  a  permit 
stub  discovered  at  the  Brooklyn  Bureau.  At  the  Brooklyn  Home  i  of 
these  was  found,  according  to  the  records,  to  have  been  transferred  from 
this  Home  on  the  date  received  at  the  Colony.  Two  others  were  found 
to  have  been  transferred  from  the  City  Home  in  Brooklyn  2  and  5  months 
previous  to  the  month  of  December,  respectively.  Another  Brooklyn  resi- 
dent who  was  a  former  inmate  of  the  Colony  was  admitted  in  this  month 
for  whom  there  was  no  permit  stub  at  the  Brooklyn  Bureau.  The  remaining 
3  of  these  7  had  also  been  inmates  of  the  Brooklyn  Home,  but  were  not, 
according  to  their  records,  transferred  from  that  Home  at  the  time  of  this 
admission  to  the  Colony. 

A  previous  resident  of  Farm  Colony  who  gave  a  Staten  Island  address 
was  also  admitted  during  this  month  of  December  for  whom  no  permit  stub 
could  be  found  at  the  Richmond  Bureau,  and  also  no  history  card.  Two 
entries  during  this  month  were  of  2  inmates  who  had  been  entered  as 
having  left  the  Colony ;  i  during  the  preceding  month,  and  the  other  8 
months  previously,  the  mistake  having  been  rectified  only  after  the  lapse 
of  these  intervals. 

During  the  month  of  May,  1912,  there  were  admitted  to  the  Colony  4 
former  inmates  with  Manhattan  addresses  for  whose  admission  at  this  time 
no  authority  could  be  found  on  the  permit  stubs  at  the  Manhattan  Bureau. 
For  3  of  these  there  were  no  permits  found  at  the  Colony.    There  was  also 

1  admission  during  this  month  from  House  of  Divine  Providence  of  a 
dependent  concerning  whom  the  Richmond  Bureau  had  no  record.  Accord- 
ing to  the  books,  3  errors  were  corrected  this  month  by  reentering  depend- 
ents who  had  been  recorded  as  discharged ;  i  7  months,  i  6  months,  and  i 

2  months  previously. 

Control  of  Admissions 

Owing  to  the  peculiar  nature  of  this  institution  the  majority  of  its  ad- 
missions are  by  transfer  from  other  boroughs  rather  than  through  the 
Bureau  of  Dependent  Adults  in  Richmond.  As  has  already  been  set  forth 
under  the  heading,  "Authority  for  Admissions,"  there  were  some  cases  which 
had  been  readmitted  by  the  order  of  the  Superintendent  of  the  Colony  for 
which  no  record  of  authorization  could  be  found  at  the  Richmond  Bureau. 
Also,  there  were  21  admissions  in  the  year  from  July  i,  191 1,  to  June  30, 


ADMISSIONS   TO   CITY   HOMES  285 

1912,  for  which  this  was  the  only  authority  entered  upon  the  books  at  the 
Colony.    (Table  XXXIV.) 

History  Records 

For  the  year  191 1  there  was  no  record  file  kept  of  the  histories  of  the  in- 
mates admitted  to  the  Colony  through  the  Manhattan  Bureau ;  consequently 
no  evidence  was  found  at  this  Bureau  of  any  effort  having  been  made 
to  gather  information  regarding  the  dependents  sent  to  the  Colony  beyond 
what  was  entered  upon  the  permits  issued  by  the  Bureau  for  their  admis- 
sion to  the  Colony.  This  information  did  not  include  any  statements  regard- 
ing the  financial  ability  or  inability  of  the  applicants  or  their  relatives  to 
relieve  the  City  of  the  cost  of  their  maintenance.  In  the  year  1912,  although 
more  effort  was  made  to  secure  the  histories  of  dependents  admitted  to  all 
institutions  in  the  Department,  and  although  history  cards  were  found  at 
this  Bureau  for  all  but  5  of  the  dependents  for  whom  there  were  also  stubs 
of  permits  for  the  Colony,  no  investigation  seemed  to  have  been  made  of  any 
of  these  dependents  at  this  time  by  this  Bureau.  No  effort  whatever  ap- 
peared to  have  been  made  by  the  Brooklyn  Bureau  during  the  entire  years 
of  191 1  and  19 1 2  either  to  fill  out  any  history  cards  or  to  make  any  investiga- 
tion of  the  dependents  for  whose  admission  to  the  Colony  permits  were 
issued. 

At  the  Richmond  Bureau  a  record  of  each  of  the  alleged  insane  com- 
mitted in  December,  191 1,  and  May,  1912,  was  found.  No  histories  were 
taken  and  no  investigation  made  in  the  case  of  6  dependents  admitted  in 
December  for  whom  there  were  permit  stubs  at  this  Bureau.  Entry  was 
made  upon  the  record  of  another  dependent  who,  according  to  the  Colony 
history,  had  been  at  that  place  in  each  of  the  years  from  1907  to  191 1,  to 
the  effect  that  a  permit  had  been  issued  because  this  dependent  had  over- 
stayed his  leave  of  absence  from  the  Colony  and  the  Superintendent  insisted 
upon  his  readmission.  For  another  dependent  admitted  through  the  Bureau 
during  these  months  notification  was  sent  to  the  Superintendent  of  the 
Colony,  after  investigation,  to  discharge  him  as  not  being  a  proper  charge 
upon  the  City.  This  appeared  to  be  the  only  admission  during  this  month 
through  this  Bureau  of  which  any  investigation  was  made. 

Four  of  the  admissions  in  May,  1912,  for  which  permits  were  issued 
by  this  Bureau  were  without  investigation.  Two  of  them  were  former  in- 
mates of  the  Colony  whose  readmission  was  approved  by  its  Superintendent ; 
another  had  been  an  absconder  from  the  Colony  and  had  returned  there  after 
30  days  in  the  Richmond  County  jail  for  vagrancy,  and  the  other  had  also 
been  an  inmate  of  the  Colony. 

The  5  other  dependents  admitted  by  permit  from  the  Richmond  Bureau 
during  this  month  were  as  follows :  i  who  upon  investigation  proved 
to  have  been  unknown  at  the  address  given  and  who  was  afterward  dis- 
charged for  not  giving  a  correct  address;  i  temporarily  admitted  to  the 
Colony  pending  arrangement  with  his  son  who  removed  him  from  the 
Colony  the  day  following  his  admission;  i  recommended  for  admission 
to  the  Colony  by  the  Superintendent  of  the  Bureau  on  account  of  her 
being  almost  constantly  under  hospital  treatment  which,  in  the  opinion 
of  the  Superintendent,  would  be  most  economically  furnished  to  her  at  the 
Colony ;  i  who  was  removed  by  her  husband  the  following  month :  and  i 
who  was  a  previous  resident  of  the  Colony  and  in  the  judgment  of  the 
Bureau  was  a  case  for  retention  there. 


286  HOSPITAL    COMMITTEE 

In  view  of  the  inadequacy  of  the  records  kept  at  the  Bureau  it  was 
evident  that  the  provision  of  the  law  was  not  being  compHed  with  by  the 
Superintendents.  Section  142  of  Article  9  of  the  State  of  New  York  reads 
as  follows : 

In  addition  to  the' general  register  of  the  inmates  of  the  various  almshouses, 
there  shall  be  kept  a  record  of  the  sex,  age,  birth-place,  birth  of  parents,  education, 
habits,  occupation,  condition  of  ancestors  and  family  relations,  and  cause  of  de- 
pendence of  each  person  at  the  time  of  admission,  with  such  other  facts  and  par- 
ticulars in  relation  thereto  as  may  be  required  by  the  State  Board  of  Charities, 
upon  forms  prescribed  and  furnished  by  such  board.  Superintendents  and  overseers 
of  the  poor,  and  other  officers  charged  with  the  relief  and  support  of  poor  persons, 
shall  furnish  to  the  keepers  or  other  officers  in  charge  of  such  almshouses  as  full 
information  as  practicable  in  relation  to  each  person  sent  or  brought  by  them  to 
such  almshouses,  and  such  keepers  or  other  officers  shall  record  the  information 
ascertained  at  the  time  of  admission  of  such  person  on  the  forms  so  furnished.  All 
such  records  shall  be  preserved  in  such  almshouses,  and  the  keepers  and  other  officers 
in  charge  thereof  shall  make  copies  of  the  same  on  the  first  day  of  each  month,  and 
immediately  forward  such  copies  to  the  State  Board  of  Charities. 

A  history  form  in  the  book  furnished  by  the  State  Board  of  Charities 
was  found  at  the  Colony  for  each  of  the  admissions  during  these  months 
of  December,  191 1,  and  May,  1912,  although  these  blanks  were  frequently 
only  partially  filled  out.  No  effort  seems  to  have  been  made  on  the  part 
of  the  Superintendents  of  the  Bureaus  of  Dependent  Adults  to  comply 
with  the  latter  part  of  this  Section  of  the  Poor  Law,  which  makes  it  manda- 
tory upon  officers  charged  with  the  relief  and  support  of  poor  persons  to 
furnish  full  information  for  each  person  sent  to  this  institution.  In  a  large 
number  of  cases  the  dependents  are  received  at  the  Colony  with  no  other  in- 
formation than  that  contained  on  the  permits  for  admission,  and  their 
histories,  which  may  have  been  taken  in  full  at  the  institution  from  which 
they  have  been  transferred,  must  be  taken  anew  at  the  Colony. 

The  record  clerk  at  the  Colony  evidently  makes  some  effort  to  connect 
the  various  admissions  of  the  same  dependent,  but  this  work  appears  to  be 
much  less  thoroughly  done  than  at  the  Manhattan  Home. 

The  Colony  possessed  the  only  card  census  of  inmates  found  in  the 
almshouses  of  the  City.  In  addition  to  this  file  a  book  is  kept  in  which  is 
recorded,  day  by  day,  the  names  and  other  identifying  data  of  all  dependents 
admitted,  and  of  all  discharged  or  having  died  on  each  day.  As  the  Colony 
is  not  a  State  Almshouse  no  State  register  for  State  Poor  cases  is  kept  here. 

The  addresses  of  dependents  kept  at  the  Colony  were  found  to  be  unsatis- 
factory for  reasons  similar  to  those  given  in  connection  with  the  two  City 
Homes.  The  91  residence  addresses  of  dependents  that  were  investigated 
for  the  admissions  during  the  month  of  May,  1912,  were  found  to  fall 
into  the  following  classes :  13,  or  14.3  per  cent.,  were  found  to  have  been 
the  residences  of  the  dependents  just  prior  to  admission  to  the  Home; 
35,  or  38.4  per  cent.,  were  addresses  where  the  dependents  were  not  known; 
8,  or  8.8  per  cent.,  were  addresses  which  the  dependents  had  left  at  a  con- 
siderable time  prior  to  their  admission ;  2,  or  2.2  per  cent.,  of  the  addresses 
given  were  not  residential  addresses ;  12,  or  13.2  per  cent.,  were  lodging 
house  addresses ;  2,  or  2.2  per  cent.,  were  outside  of  the  City ;  12,  or  13.2  per 
cent.,  were  addresses  insufficient  for  investigation;  and  7,  or  y.y  per  cent, 
of  the  dependents  were  admitted  without  any  residential  address.  (Table 
XXXVII.) 

On  the  records  of  these  same  May  admissions  90  addresses  of  friends 
or  relatives  given  for  notification  in  case  of  necessity  were  investigated: 


ADMISSIONS   TO   CITY  HOMES  287 

24,  or  26.7  per  cent,  were  found  to  have  been  the  actual  residences  of  the 
relatives  or  friends  ;  32,  or  35.5  per  cent.,  were  addresses  where  these  friends 
were  not  known;  5,  or  5.6  per  cent.,  were  addresses  which  the  friends  or 
relatives  had  left  at  a  considerable  time  before  the  admission  of  the  de- 
pendents; 9,  or  10  per  cent.,  were  out-of-town  addresses;  3,  or  3.3  per  cent., 
were  lodging  house  addresses ;  8,  or  8.9  per  cent.,  of  the  addresses  were  in- 
sufficient for  investigation;  9,  or  10  per  cent.,  of  the  addresses  were  not 
residential.     (Table  XXXVIII.) 

In  the  month  of  December,  191 1,  of  the  109  addresses  of  dependents  that 
were  investigated,  only  9,  or  8.2  per  cent.,  were  found  to  have  been  the  cor- 
rect addresses  of  the  dependents  just  prior  to  admission;  i,  or  0.9  per  cent., 
was  an  old  address;  and  i,  or  0.9  per  cent.,  was  outside  of  the  City.  At  8, 
or  7.3  per  cent.,  of  the  addresses  the  dependents  were  unknown;  5,  or  4.6 
per  cent.,  of  the  addresses  were  other  than  residential;  7,  or  6.4  per  cent., 
were  insufficient  for  a  visit;  13,  or  12  per  cent.,  were  addresses  of  lodging 
houses;  while  65,  or  59.7  per  cent.,  of  the  admissions  this  month  had  upon 
their  history  records  at  the  Colony  no  address  of  any  residence  outside  of 
the  institutions  of  New  York.     (Table  XXXIX.) 

In  this  same  month  of  December  67  addresses  of  relatives  and  friends 
were  examined  and  only  22  of  them,  or  32.8  per  cent.,  were  found  to  have 
been  accurate  (Table  XL) ;  i,  or  1.4  per  cent.,  was  an  old  address;  15,  or 
22.4  per  cent.,  were  out-of-town  addresses;  15,  or  22.4  per  cent.,  were  ad- 
dresses where  these  friends  were  unknown ;  3,  or  4.5  per  cent.,  were  lodging 
house  addresses;  6,  or  9  per  cent.,  were  addresses  of  places  that  were  not 
residential;  while  5,  or  7.5  per  cent.,  were  addresses  insufficient  for  a  visit. 

Character  of  Dependents 

An  examination  was  made  of  all  the  admissions  to  the  Colony  during 
the  month  of  May,  1912,  amounting  to  98,  and  of  90  of  the  145  admissions 
during  the  month  of  December,  191 1  (the  remaining  55  cases  in  December 
were  not  investigated  on  account  of  the  pressure  of  other  work),  to  see 
what  action  had  been  taken  in  accordance  with  the  powers  and  duties  of 
the  Commissioner  of  Public  Charities,  conferred  by  Section  663  of  the 
Charter  of  the  City  of  New  York,  as  follows: 

It  shall  be  the  duty  of  the  Commissioner  of  Public  Charities  to  investigate  the 
circumstances  of  every  person  admitted  to  an  institution  under  his  charge  and  of 
the  near  relatives  of  such  person.  Such  investigation  shall  be  made,  when  prac- 
ticable, before  the  admission  of  such  person,  and  the  results  of  investigation  shall 
be  placed  on  file  and  preserved  with  the  records  of  the  Department     .     .     . 

Investigators  of  the  Committee  could  not  secure  sufficient  information 
for  51,  or  52  per  cent.,  of  the  98  admissions  in  the  month  of  May,  1912,  to 
make  their  classification  possible.  This  failure  was  due  to  the  following 
reasons : 

The  addresses  found  at  the  Colony  were  insufficient  in 13  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 31       " 

The  addresses  given  were  too  old  in 3       " 

Sufficiently  complete  histories  could  not  be  secured  in 4       " 


Total 51  Cases 


288  HOSPITAL   COMMITTEE 

(a)  Classification  of  Dependents 

In  the  remaining  47  cases  the  facts  seemed  to  justify  their  classification 
as  follows : 

Dependents    who  seemed  to   have   had   a    legitimate  claim  upon  the 

City's   support : 17,  or  36.2% 

Dependents  who  were  aliens IG,   "  34.0% 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 

maintenance 1,   "     2.1% 

Dependents  who  were  personally  able  to  pay  for  their  maintenance 1,   "     2.1% 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy 1,   "     2.1% 

Dependents  who  had  relatives,  willing  to  support  them  in  their  own  homes       1,   "     2.1% 

Dependents  who  were  able  to  work  to  earn  their  own  support 1,   "     2.1% 

Dependents  who  were  committed  by  magistrates  for  observation  as  to 

their  sanity 7,   "  15.0% 

Dependents  who  had  relatives  not  legally  responsible  but  able  to  pay  for 

their  maintenance 2,   "     4.3% 

Total 47,  or  100.0% 

(b)  Estimate  of  Expense 

The  expense  of  the  maintenance  of  these  47  dependents  by  the  City  was 
estimated  as  follows :  From  the  history  books  of  the  Colony  were  secured 
the  different  periods  of  stay  of  these  dependents  at  the  Colony.  The 
periods  of  stay  of  those  dependents  who  were  remaining  in  the  Colony  in 
August  when  this  examination  was  made  were  reckoned  only  to  the  date 
of  examination.  The  per  capita  per  diem  expense  per  dependent  in  the 
Colony  as  published  in  the  Annual  Reports  of  the  Department  was  used 
and  an  average  estimated  for  the  last  5  years.  This  average  was  used  as  the 
multiplier  in  estimating  at  what  expense  these  dependents  had  been  main- 
tained in  this  institution.  As  the  records  of  the  various  admissions  of  the 
same  dependents  are  much  less  carefully  associated  at  this  institution,  it  is 
probable  that  an  underestimate  has  been  made  of  the  number  of  days  of  stay 
of  these  dependents.  Also,  as  it  is  understood,  the  per  capita  per  diem  ex- 
pense given  in  the  Annual  Reports  of  the  Department  corresponds  to  the 
maintenance  expense  of  the  dependents  and  the  local  expense  incurred  in 
the  development  of  the  property,  and  does  not  include  any  portion  of  the 
general  administrative  expense  of  the  Department,  the  expense  incurred  on 
corporate  stock  issues,  or  any  other  expense  of  a  general  nature.  The 
figures  given,  therefore,  in  the  following  estimate  only  partially  represent  the 
actual  cost  incurred  by  the  City  for  these  dependents. 

Owing  to  the  fact  that  this  institution  was  comparatively  a  small  one  until 
the  recent  opening  of  the  new  dormitories,  the  opportunity  for  length  of 
stay  was  much  less  here  than  at  the  older  Homes  in  Brooklyn  and  Man- 
hattan. 

The  dependents  regarding  whom  findings  have  just  been  given  were 
segregated  into  the  following  groups,  as  in  connection  with  the  City  Homes 
in  this  Report: 
Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 
maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents   of  the  City. 
The  dependents  in  Group  I  remained  in  the  Colony,  after  their  various 
admissions,  1,722  days,  at  an  estimated  expense  to  the  City  for  maintenance 
of  $808,48. 


ADMISSIONS   TO   CITY   HOMES  289 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 
Dependents  who  were  wives  or  children  of  men  who  had  served  in  the 
U.  S.  Army  or  Navy. 

The  dependents  in  Group  II  remained  in  the  Colony,  after  the  various 
admissions,  263  days,  at  an  estimated  expense  to  the  City  for  maintenance 
of  $123.49. 

Group  III. 
Dependents  who  had  relatives  not  legally  responsible  for  their  support 

but  able  to  pay  for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their 

own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

The  dependents  in  Group  III  remained  in  the  Colony,  after  their  various 
admissions,  454  days,  at  an  estimated  expense  to  the  City  for  maintenance 
of  $213.15.  This  would  make  a  total  estimated  cost  to  the  City  of  these  de- 
pendents under  these  three  groups  of  $1,145.12.     (Table  XLII.) 

Had  the  proportions  in  the  different  classes  of  the  dependents  that  could 
be  classified  held  good  for  all  admitted  during  this  month,  the  cost  of 
maintenance  of  these  three  groups  would  have  been  as  follows : 

Group     I $1,755.79 

Group    II 165.82 

Group  III 447.62 

Total S2,369.23 

The  90  cases  for  the  month  of  December,  191 1,  were  even  less  pro- 
ductive of  satisfactory  information,  for,  of  this  number,  55,  or  61.8  per 
cent.,  of  these  cases  were  dependents  about  whom  sufficient  information 
could  not  be  gathered,  for  the  following  reasons : 

The  addresses  found  at  the  Colony  were  insufficient  in 23  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 27      " 

Sufficiently  complete  histories  could  not  be  secured  in 5      " 

Total 55  Cases 

(aa)     Classification  of  Dependents 

The  remaining  35  cases  were  found  to  consist  of  the  following: 
Dependents  who  seemed  to  have  had  a  legitimate  claim  upon  the  City's 

support 10,  or  28.6% 

Dependents  who  were  aliens 17,   "  48 . 6% 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 

maintenance 4,   "  11.5% 

Dependents  who  were  personally  able  to  pay  for  their  maintenance.  ...  2,   "     5.7% 

Dependents  who  were  able  to  work  to  earn  their  own  support 1,   "     2.8% 

Dependents  who  had  relatives  willing  to  support  them  in  their  own  homes  1,  "     2.8% 

Total 35,  or  100.0% 

(bb)     Estimate  of  Expense 

Employing  the  same  groupings  for  the  month  of  December  as  for  May, 
it  was  found  that  the  dependents  in  Group  I  remained  at  the  Colony  for  a 
total  of  5,537  days,  at  an  expense  of  $2,599.62 ;  that  there  were  no  depend- 
ents for  Group  II ;  and  that  those  for  Group  III  remained  in  the  institution 


290  HOSPITAL   COMMITTEE 

a  total  of  159  days,  at  an  expense  of  $74.65,  making  a  total  estimated  cost 
to  the  City  for  these  dependents  of  $2,674.27. 

Extending  these  same  proportions  to  all  of  the  admissions  in  this  month 
the  cost  of  maintenance  of  these  dependents  would  thus  have  fallen  into 
groups  as  follows : 

Group     I $10,956.50 

Group  III 314.62 

Total Sll,271.12 

(c)  United  States  Soldiers  and  Families 

A  portion  of  Section  80  of  Article  6  of  the  Poor  Law  of  the  State  of 
New  York  is  again  quoted  as  follows : 

No  poor  or  indigent  soldier,  sailor  or  marine  who  has  served  in  the  military 
or  naval  service  of  the  United  States,  nor  his  family,  nor  the  families  of  any  vifho 
may  be  deceased,  shall  be  sent  to  any  almshouse,  but  shall  be  relieved  and  provided 
for  at  their  homes  in  the  city  or  town  where  they  may  reside,  so  far  as  practicable, 
provided  such  soldier,  sailor  or  marine  or  the  families  of  those  deceased,  are,  and 
have  been,  residents  of  the  State  for  one  year.     .     .     . 

In  disregard  of  this  prohibition  a  former  soldier  in  the  U.  S.  Army  was 
admitted  to  this  Colony  during  the  month  of  May. 

(d)  Removal  of  Aliens  and  Non-Residents 

Under  Section  17  of  Article  2  of  the  State  Charities  Law,  which  has 
been  quoted  in  part  in  this  Report  on  page  265,  the  State  Board  of  Charities, 
and  any  of  its  officers  and  members  may  at  any  time  visit  the  institutions 
subject  to  its  supervision  and  remove  all  aliens  and  non-residents  who  are 
public  charges  for  transportation  to  the  proper  states  or  countries. 

During  the  month  of  May,  1912,  there  were  14  aliens  in  this  institution, 
and  in  December,  191 1,  there  were  15,  all  of  whom  were  recorded  as  aliens 
upon  the  books  of  the  Colony.  There  is  no  evidence  that  any  of  these  aliens 
were  reported  to  the  State  Board  of  Charities  by  the  Colony,  and  the 
monthly  reports  of  the  State  Board  of  Charities  do  not  show  that  any 
of  them  were  removed  from  this  institution  by  the  Board. 

Although  84  of  the  98  dependents  admitted  to  the  Colony  in  May,  1912, 
had  previously  been  inmates  of  municipal  institutions,  as  was  shown  upon 
the  records  of  the  Colony— some  having  been  in  more  than  one  institution — 
and  although  5  other  dependents  admitted  had  previously  been  inmates 
of  private  institutions,  no  evidence  was  apparent  of  any  effort  having  been 
made  to  obtain  the  previous  histories  of  these  dependents  either  by  the 
Colony  itself  or  by  the  Bureau  of  Dependent  Adults  of  Manhattan,  Rich- 
mond, or  Brooklyn. 

The  same  lack  of  effort  appeared  in  connection  with  admissions  in  the 
month  of  December,  191 1,  when  119  of  the  145  inmates  appeared  upon  the 
records  of  the  Colony  as  previous  inmates  of  municipal  institutions  and 
3  other  inmates  appeared  as  having  been  in  private  institutions. 

(e)  Comparison  of  Findings 

For  the  admissions  to  the  Colony  in  the  month  of  December,  191 1,  there 
could  be  found  no  history  cards  and  no  records  of  any  investigation  by  any 
one  of  the  three  Bureaus  of  Dependent  Adults.     The  admissions  in  May, 


ADMISSIONS   TO   CITY  HOMES 


291 


1912,  through  the  Brooklyn  Bureau  also  had  not  been  investigated  and  had 
no  history  cards  at  the  Bureau.  Only  4  of  the  admissions  through  the 
Manhattan  Bureau  were  found  to  have  come  under  the  observation  of  the 
Superintendent  of  the  Bureau  or  one  of  his  Examiners,  and  no  investi- 
gation appeared  to  have  been  made  by  this  Bureau  in  connection  with  any 
of  these  admissions.  Consequently  there  were  no  findings  to  be  compared 
with  the  findings  of  the  Committee's  investigators. 

There  were  a  few  cases  for  which  records  were  on  file  at  the  Richmond 
Bureau.  A  comparison  of  two  of  these  records  and  the  findings  of  the 
Committee's  investigators  follows: 

Case  10.  The  investigator  of  the  Committee  found  that  this  dependent  had 
a  son  and  a  married  daughter  who  were  able  and  willing  to  care  for  and  maintain 
their  mother.  The  dependent  was  said  to  have  entered  the  Colony  because  of  a 
difference  with  her  husband. 

The  Bureau  had  a  record  of  this  case  2  years  before  the  time  of  this  admission 
to  the  effect  that  this  dependent  was  living  on  the  charity  of  neighbors  and  had 
no  one  else  to  aid  her.  Within  2  weeks  of  the  time  of  this  admission  the  history 
card  at  the  Bureau  was  marked  disapproved.  The  dependent  remained  in  the  in- 
stitution for  19  days  and,  according  to  the  records  at  the  Colony,  was  taken  away 
from  there  by  her  husband  at  her  own  request. 

Case  61.  The  investigator  of  the  Committee  received  information  at  a  former 
place  of  employment  of  this  dependent  that  he  had  no  relatives  in  this  country. 
The  records  at  the  Colony  showed  that  this  dependent  was  an  alien. 

The  Bureau  had  no  information  on  its  history  card  regarding  the  family  of  this 
dependent.  The  record  there  was  to  the  effect  that  he  had  been  30  days  in  jail  for 
vagrancy.  No  evidence  was  found  to  show  that  this  case  had  been  reported  to  the 
State  Board  of  Charities  for  investigation  for  possible  deportation. 

TABLE  I. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Admissions  from  January  i,  1911,  to  December  31,  iqii.^ 

Sources 


IS 

0 

D.ti 

if 

0. 0. 

>> 

0 

a, 
0 

■a 
0 

0 

Lebanon 
Hospita 

Total 

1911 

Male  Fem 

M.    F. 

M. 

F. 

M.    F. 

M. 

F. 

M.F. 

M.F. 

M.F. 

January 

...   207    81 

2      4 

2 

6 

3     17 

2 

1 

1     1 

1     1     329 

February 

...   110     63 

4      5 

6 

8 

10     12 

4 

4 

..    ..     226 

March 

...  217     95 

9      4 

S 

12 

5     .. 

3 

4 

i 

..     1     359 

April 

...  216     88 

13     10 

S 

5 

9       9 

2 

2 

..     2 

. .     1     365 

May 

...  291  120 

18    23 

1 

1       2 

4 

6 

1     1 

..     1     469 

Tune 

...  259  107 

18      8 

17 

12 

1       1 

6 

3 

..     3 

..    ..     435 

July 

...   174    65 

23     20 

1 

2 

3 

4 

2    2 

1 

..    ..     297 

August 

...  246    86 

26     15 

14 

10 

4 

1 

1   .. 

i 

..    ..     405 

September . . . . 

...   177     54 

14     10 

12 

1 

1       5 

2 

3 

..    ..     279 

October 

...   241     72 

19     12 

V 

s 

2     11 

1 

3 

..     2 

..    ..     378 

November .  . . . 

...   175    84 

15     15 

6 

1 

1       4 

2 

2 

..     2 

1 

..    ..     308 

December 

...    161     75 

10     11 

12 

5 

1       3 

3 

2 

..     1 

..    ..     284 

Total 

. .  2,474  990 

171  137 

93 

71 

35    64 

36 

35 

5  14 

2 

2 

1     4  4,134 

Note:     647,  or  15.6  per  cent,  of  the  total  admissions,  were  by  transfers  from  hospitals. 
47,  or  16.5  per  cent,  of  the  total  admissions  in  December,  were  by  transfers  from  hospitals. 
1  Taken  from  the  monthly  reports. 


292 


HOSPITAL   COMMITTEE 


TABLE  II. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Admissions  from  January  i,  IQ12,  to  June  30,  iqi2.^ 

Sources 


.2-C 

SO 


1912 


„  .J  rt*^ 

o  m  S  o        ffi 

Male  Fern.   M.      F.     M.    F.    M.    F.    M.    F. 


January 132  75  12  12  10 

February 119  48  15  18  .  . 

March 193  72  32  22  20 

April 219  77  19  21  4 

May 200  83  42  32  1 

June 171  93  27  29  36 


9    O 

^    E 

I    I 

M.F.  M.F. 


4  2 


1  .. 

2  .. 


251 
210 
367 
356 
373 
387 


Total. 


1,034    448     147     134    71     11     19      9     33    24    3    6     5     0    1,944 


Note:  448,  or  23.5  per  cent,  of  the  total  admissions,  were  by  transfers  from  hospitals. 
87,  or  23 . 3  per  cent.fof  the  total  admissions  in  May,  were  by  transfers  from  hospitals. 
*  Taken  from  the  monthly  reports. 


TABLE  III. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Causes  of  Dependence  of  Inmates  Admitted  from  January  i,  igi2,  to  June  30,  igi2.^ 


Lack  of  Aged 
1912                  Employ-    Sickness        and 

ment  Infirm 

January 85  90           68 

February 72  85            52 

March 161  135            71 

April 199  120            37 

May 134  175           60 

June 130  210           47 

Tot 

Per 

'  Taken  from  the  monthly  reports. 
'  Alcoholic. 


Blind      Lost    Unknown  Total 


251 
210 
367 
356 
373 
387 


Total 

781 

815 

335 

9 

2 

2 

1,944 

Percentage 

....       40.2 

42.0 

17.2 

.4 

.1 

.1 

100.0 

ADMISSIONS   TO    CITY   HOMES  293 

TABLE  IV. 
New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Authorizations  for  Admission  Found  on  File  at  the  Home  for  the  186   Male  Admissions 
in  December,  igii.^ 

Admissions  Having  Authorizations  at  the  Home  from  the  Bureau 
OF  Dependent  Adults 181 

Permits  bearing  the  name  of  the  Superintendent  of  the  Bureau 165 

Permits  bearing  the  name  of  the  Examining  Physician 15 

Permits  without  Physician's  name  from  the  ofi&ce  of  the  Examining 

Physician 1 

181 

Admissions  not  Having  Authorizations  at  the  Home  from  the  Bureau 

of  Dependent  Adults 5 

Admission  slips  bearing  the  name  of  a  doctor  at  Harlem  Hospital ....  2 

Admission  slips  from  the  Reception  Hospital  bearing  the  name  of  an 

interne  at  Metropolitan  Hospital 1 

Admissions  for  which  there  were  no  slips  or  permits  found  on  file 

at  the  Home 2 

6 
Total 186 


1  Taken  from  the  admission  records. 


TABLE  V. 
New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Authorizations  for  Admission    Found  on  File  at  the  Home  for  the  253  Male  Admissions 
in  May,  1912.^ 


Admissions  Having  Authorizations  at  the  Home  from  the  Bureau 
OF  Dependent  Adults 243 

Permits  bearing  the  name  of  the  Superintendent  of  the  Bureau ....  142 
Permits  bearing  the  name  of  the  Examining  Physician 101 

243 

Admissions  not  Having  Authorizations  at  the  Home  from  the  Bureau 
OF  Dependent  Adults 10 

Admission  slips  bearing  the  name  of  a  doctor  at  Harlem  Hospital ....  4 

Admission  slips  bearing  the  names  of  doctors  on  Blackwells  Island. . .  4 
Admission  slips  bearing  the  name  of   the  Superintendent  of  New 

York  City  Farm  Colony 1 

Admissions  for  which  there  were  no  slips  or  permits  found  on  file 

at  the  Home 1 

10 
Total 253 

'  Taken  from  the  admission  records. 


294 


HOSPITAL   COMMITTEE 


TABLE  VI. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Records  of  Authorizalions  Found  at  the  Bureau  of  Dependent  Adults,  Manhattan,  for  the  253 

Male  Admissions  to  the  Home  in  May,  IQI2,^  Compared  with  the  Authorizations 

for  Admission  Found  on  File  at  the  Home. 

Admissions  Having  Stubs  of  Permits  at  the  Bureau  of  Dependent 

Adults 134 

With  permits  at  the  Home  bearing  the  name  of  the  Superintendent 
of  the  Bureau 134 

Admissions  not  Having  Stubs  of  Permits  at  the  Bureau  of  Dependent 
Adults 119 

With  permits  at  the  Home  bearing  the  name  of  the  Superintendent 
of  the  Bureau 8 

With  permits  at  the  Home  bearing  the  name  of  the  Examining  Phy- 
sician         101 

With  admission  slips  at  the  Home  bearing  the  name  of  a  doctor  at 

Harlem  Hospital 4 

With  admission  slips  at  the  Home  bearing  the  names  of  doctors  on 

Blackwell's  Island 4 

With  admission  slips  at  the  Home  bearing  the  name  of  the  Superin- 
tendent of  Farm  Colony 1 

With  no  admission  slips  or  permits  on  file  at  the  Home 1 

119 
Total 253 

'  Taken  from  the  admission  records. 


ANALYSIS  OP  THE  574  DISCHARGES  FROM  NEW  YORK  CITY  HOME  FOR 

THE  AGED  AND  INFIRM,  MANHATTAN    DIVISION,  FOR  TRANSFER  TO 

NEW    YORK    CITY    FARM    COLONY,    FROM    JANUARY    1,    1910,    TO 

TUNE    30,    1912;    THEIR    DISPOSAL    AT     FARM    COLONY;    AND 

THEIR  READMISSION  TO  THE  CITY  HOME. 


SUMMARY  NO.  I. 
First  Discharge 

I.  Process  of  Transfer 

Dependents  discharged  first  time  for  transfer 554 

Dependents  who  failed  to  arrive  at  Farm  Colony 23 

Dependents  who  arrived  at  Farm  Colony 531 

554 

II.  Disposal  at  Farm  Colony 

Dependents  received  on  first  transfer 531 

Dependents  remaining  at  Farm  Colony  in  August,  1912 235 

Dependents  who  died  at  Farm  Colony 21 

Dependents  retransf erred  to  other  iastitutions 35 

Dependents  who  left  Farm  Colony  without  transfer  or  death. . .  240 

531 

Dependents  who  left  Farm  Colony  without  transfer  or  death . . .  240 


III.   Dependents  Readmitted  to  City   Home  After  First  Dis- 
charge  


103 


ADMISSIONS   TO   CITY  HOMES  295 

Second  Discharge 

I.  Process  of  Transfer 

Dependents  discharged  second  time  for  transfer 17 

Dependents  who  failed  to  arrive  at  Farm  Colony 1 

Dependents  who  arrived  at  Farm  Colony 16 

17 

II.  Disposal  at  Farm  Colony 

Dependents  received  on  second  transfer 16 

Dependents  remaining  at  Farm  Colony  in  August,  1912 5 

Dependents  who  died  at  Farm  Colony 1 

Dependents  who  left  Farm  Colony  without  transfer  or  death. ...  10 

16 

Dependents  who  left  Farm  Colony  without  transfer  or  death. . .  10 

III.  Dependents  Readmitted  to  City  Home  After  Second  Discharge  4 

Third  Discharge 

I.  Process  of  Transfer 

Dependents  discharged  third  time  for  transfer 2 

Dependents  who  arrived  at  Farm  Colony 2 

II.  Disposal  at  Farm  Colony 

Dependents  received  on  third  transfer 2 

Dependents  remaining  at  Farm  Colony  in  August,  1912 1 

Dependents  who  left  Farm  Colony  without  transfer  or  death ....  1 

2 

Dependents  who  left  Farm  Colony  without  transfer  or  death. ...  1 

III.  Dependents  Readmitted  to  City  Home  After  Third  Discharge  1 

Fourth  Discharge 

I.  Process  of  Transfer 

Dependents  discharged  fourth  time  for  transfer 1 

Dependents  who  arrived  at  Farm  Colony 1 

II.  Disposal  at  Farm  Colony 

Dependents  retransf erred  to  other  institutions 1 

III.  Dependents  Readmitted  to  City  Home 0 


TABLE  VII. 
Rearrangement  of  Summary  No.  I,  with  Totals  Added. 


Process  of 

Transfer 

Disposal  at 

Farm  Colony 

Read- 
mitted 
to 

City 
Home 

Total 
Dis- 
charged 

Failed 

to 
Arrive 

at 
F.  C. 

Arrived  Remain- 

at          ing  at 

F.  C.        F.  C. 

Died 

at 

F.  C. 

Transfers 

from 

F.  C.  to 

Other 

Inst'ns 

All 
Others 

Who 

Left 
P.  C. 

First  Discharge. . . 

554 

23 

531 

235 

21 

35 

240 

Readmitted 

Second  Discharge. 

103 

"ii 

"i 

"ie 

'"'5 

"i 

"io 

Readmitted 

Third  Discharge. . 

4 

'"2 

'"2 

"i 

"i 

Readmitted 

Fourth  Discharge. 

1 

"i 

"i 

"i 

108 

574 

24 

550 

241 

22 

36 

251 

296 


HOSPITAL   COMMITTEE 


TABLE  VIII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Dependents  Readmitted  After  Their  First  Discharge  from  the  City  Home,   between  Jan- 
uary I,  ipio,  and  June  30,  IQ12,  for  Transfer  to  New  York  City  Farm  Colony. 


Reasons  for  Leaving 
Farm  Colony 
Failed  to  arrive  at  Farm 

Colony 6 

On  Farm  Colony  book  as 

not  discharged 1 

Absconded 46 

By  own  request 20 

Overstayed  passes 6 

Discharged  by   order  of 

Superintendent 7 

Transferred     to     Metro- 
politan Hospital 1 

Transferred  to   Manhat- 
tan State  Hospital ....     1 
Transferred  to  City  Home    6 
Transferred  to  City  Hos- 
pital       2 

Transferred  to  Pay  RoU 


Means  of  Re.\DxMission 
to  the  Home 

Bureau     of     Dependent 
Adults 96 

Transferred  by  order  of 
Dr.  Schultze 1 

Transferred  from  Metro- 
politan Hospital 2 

Transferred   from   Farm 
Colony 4 


Unexplained 5 

Total 103 


Total 103 


Disposition  at  the 
Home 

Died 10 

Transferred  to  Pay  Roll .     1 
Transferred  to  State  Reg- 
ister       1 

Discharged  to  State  Board 

of  Charities  Agent. ..  .      1 
Transferred  to  Farm  Col- 
ony     13 

Refused  to  work 2 

Remaining  in  the  Home, 

August  1,  1912 16 

Unknown 59 


Total. 


.103 


TABLE  IX. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Findings  as  to  the  History  Records  at  the  Bureau  of  Dependent  Adults,  Manhattan,  for  the  253 

Male  Admissions  in  May,  iQis,^  Compared  with  the  Authorizations  for  Admission 

Found  on  File  at  the  City  Home. 

Admissions  Having  History  Records  at  the  Bureau  of  Dependent 
Adults 217 

With  permits  at  the  Home  bearing  the  name  of  the  Superintendent  of 

the  Bureau 115 

With  permits  at  the  Home  bearing  the  name  of  the  Examining  Phy- 
sician         100 

With  admission  slips  at  the  Home  bearing  the  name  of  a  doctor  at 
Harlem  Hospital 1 

With  no  permits  or  admission  slips  at  the  Home  (this  history  card  is 
for  a  previous  admission) 1 

217 
Admissions  not  Having  History  Records  at  the  Bureau  of  Dependent 

Adults 36 

With  permits  at  the  Home  bearing  the  name  of  the  Superintendent  of 

the  Bureau 27 

With  permits  at  the  Home  bearing  the  name  of  the  Examining  Phy- 
sician    1 

With  admission  slips  at  the  Home  bearing  the  name  of  a  doctor  at 

Harlem  Hospital 3 

With  admission  slips  at  the  Home  bearing  the  names  of  doctors  on 

BlackweU's  Island 4 

With  admission  slips  at  the  Home  bearing  the  name  of  the  Superin- 
tendent of  Farm  Colony 1 

36        

253 

'  Taken  from  the  admission  records. 


ADMISSIONS   TO    CITY   HOMES  297 

TABLE  X 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Findings  as  to  the  Reviews  of  the  History   Records  at  the   Bureau   of  Dependent  Adults, 

Manhattan,  by  the  Examiners  of  Charitable  Institutions  and  the  Superintendent  of 

the  Bureau  for  the  253  Male  Admissions  in  May,  1912,^  Compared  with  the  Stubs 

of  Permits  for  Admission  to  the  Home  Found  at  the  Bureau. 

Admissions  Having  History  Records  at  the  Bureau  Reviewed  by  an 

Examiner  or  the  Superintendent 101 

With  permit  stubs  at  the  Bureau 9 

With  no  permit  stubs  at  the  Bureau 92 

101 
Admissions  Having  History  Records  at  the  Bureau  not  Reviewed 

BY  an  Examiner  or  the  Superintendent 116 

With  permit  stubs  at  the  Bureau 100 

With  no  permit  stubs  at  the  Bureau 16 

Admissions  not  Having  History  Cards  at  the  Bureau 36 

With  permit  stubs  at  the  Bureau 25 

With  no  permit  stubs  at  the  Bureau 11 

36 

Total 253 

*  Taken  from  the  admission  records. 

TABLE  XI. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  166  Dependents  Entered 
upon  the  Records  of  Admission  in  December,  191 1. 

Residences  of  dependents  just  prior  to  admission 20,  or  12.0% 

Residences  of  dependents  at  some  time  before  admission 3,  "     1.8% 

Addresses  where  dependents  were  not  known 35,  "  21.0% 

Addresses  of  lodging  houses 49,  "  29 . 5% 

Addresses  that  were  not  residential 9,  "     5.5% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 4,  "     2.4% 

Addresses  that  were  outside  of  the  City 3,  "     1-8% 

Dependents  admitted  without  residential  addresses 43,  "  26.0% 


Total 166,  or  100 . 0% 

TABLE  XII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Findings,  After  Investigation,  Regarding  the  Residence  A  ddresses  of  161  Relatives  and  Friends 
of  Dependents  Entered  upon  the  Records  of  Admission  in  December,  igii. 

Residences  of  relatives  or  friends  just  prior  to  the  admission 65,  or  40.4% 

Residences  of  relatives  or  friends  at  some  time  before  the  admission 9,   "     5.6% 

Addresses  where  relatives  or  friends  were  not  known 40,   "  24.8% 

Addresses  of  lodging  houses 8,  "     5.0% 

Addresses  that  were  not  residential 12,  "     7.5% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 6,   "     3.7% 

Addresses  that  were  outside  of  the  City 21,   "  13.0% 

Total 161,or  100.0% 

Note:     The  records  for  35  admissions  during  this  month  had  no  names  and  addresses 
ot  relatives  or  friends  entered  upon  them. 


29S  HOSPITAL   COMMITTEE 

TABLE  XIII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  231  Dependents  Entered 

upon  the  Records  of  Admission  in  May,  igi2. 

Residences  of  dependents  just  prior  to  admission 62,  or  26.9% 

Residences  of  dependents  at  some  time  before  admission 4,   "     1.7% 

Addresses  where  dependents  were  not  known 60,   "  26 . 0% 

Addresses  of  lodging  houses 55,   "  23.9% 

Addresses  that  were  not  residential 10,   "     4.3% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 3,   "     1.2% 

Addresses  that  were  outside  of  the  City 1,   "       .4% 

Dependents  admitted  without  residential  addresses 36,   "  15.6% 

Total 231, or  100.0% 

TABLE  XIV. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  246  Relatives  and  Friends 

of  Dependents  Entered  upon  the  Records  of  A  dmission  in  May,  1 91 2. 

Residences  of  relatives  or  friends  just  prior  to  the  admission 137,  or  55.6% 

Residences  of  relatives  or  friends  at  some  time  before  the  admission 9,   "     3.6% 

Addresses  where  relatives  or  friends  were  not  known 50,   "  20.2% 

Addresses  of  lodging  houses 12,   "     4.8% 

Addresses  that  were  not  residential 16,   "     6.5% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 7,   "     2.8% 

Addresses  that  were  outside  of  the  City 15,   "     6.5% 

Total 246, or  100.0% 

Note:     The  records  for  26  admissions  during  this  month  had  no  names  and  addresses 
of  relatives  or  friends  entered  upon  them. 

TABLE  XV. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Findings,   After  Investigation,   Regarding  the   Character  of  the  1S6   Male  Dependents 

Admitted  in  December,  ipii. 

Admissions  That  Could  Not  be  Classified  as  to  Character  for  the 
Following  Reasons:  99 

The  addresses  found  at  the  Home  were  insxifficient  in 37  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 40      " 

The  addresses  given  were  too  old  in 3      " 

SufBciently  complete  histories  could  not  be  secured  in 19      " 

Total 99  Cases 

Admissions  Classified  as  to  Character:  87 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon 
the  City's  support 29,  or  33.3% 

Dependents  who  were  aliens 38,   "  43 . 6% 

Dependents  who  did  not  have  a  legal  settlement  in  New  York 
City 12,  "  13.8% 

Dependents  who  had  legally  responsible  relatives  able  to  pay 

for  their  maintenance 2,   "     2.3% 

Dependents  who  were  personally  able  to  pay  for  their  main- 
tenance        2,  "     2.3% 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy 2,  "     2.3% 

Dependents  who  had  relatives   willing   to  support   them   in 

their  own  homes 1,   "     1-2% 

Dependents  who  were  able  to  work  to  earn  their  own  support.       1,  "     1.2% 
Total 87,or  100.0% 

186 


ADMISSIONS   TO   CITY   HOMES  299 

TABLE  XVI. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Male  Dependents  Admitted  in  December, 
1911,  and  Found,  After  Investigation,  to  Fall  into  Certain  Groups. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     I $5,363.11 

Group    11 235.69 

Group  III 102.48 

Total $5,701.28 


TABLE  XVII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Male  Dependents  Admitted  in  December, 

igii:  for  Those  Found,  After  Investigation,  to  Fall  into  the  Groups  Shown;  and  for 

Those  Who  Could  Not  be  Classified,  but  Who  Would  Have  Fallen  into  These 

Groups  on  the  Basis  of  the  Proportions  in  Each  Group  of  Those  Classified. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense; 

Group     I §10,726.22 

Group    II 471.38 

Group  III 204.96 

Total Sll,402.56 


300  HOSPITAL   COMMITTEE 

TABLE  XVIII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Findings,  After  Investigation,  Regarding  the  Character  of  tlie  253  Dependents  Admitted 
in  May,  1912. 

Admissions  That  Could  Not  be  Classified  as  to  Character  for  the 
Following  Reasons:  87 

The  addresses  found  at  the  Home  were  insufficient  in 24  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 43      " 

The  addresses  given  were  too  old  in 1  Case 

Sufficiently  complete  histories  could  not  be  secured  in 19  Cases 

Total 87  Cases 

Admissions  Classified  as  to  Character:  166 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon 
the  City's  support 86,  or  51.8% 

Dependents  who  were  aliens 50,   "  30.2% 

Dependents  who  did  not  have  a  legal  settlement  in  New  York 
City 4,   "     2.4% 

Dependents  who  had  legally  responsible  relatives  able  to  pay 

for  their  maintenance 11,   "     6.6% 

Dependents  who  were  personally  able  to  pay  for  their  main- 
tenance         2,  "     1.2% 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy 3,   "     1.8% 

Dependents  who  had  relatives  willing  to  support  them  in  their 

own  homes 2,   "     1.2% 

Dependents  who  had  relatives  not  legally  responsible  but  able 
to  pay  for  their  maintenance 4,  "     2.4% 

Dependents  who  were  able  to  work  to  earn  their  own  support      4,   "     2.4% 

Total 166,  or  100 .0% 

253 


TABLE  XIX. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Male  Dependents  Admitted  in  May, 
IQ12,  and  Found,  After  Investigation,  to  Fall  into  Certain  Groups. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 
Dependents  who  were  personally  able  to  pay  for  their  maintenance. 
Dependents  who  were  aliens. 
Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  wUling  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     1 83,793.72 

Group    II 1,579.94 

Group  III 485.52 

Total 85,859.18 


ADMISSIONS   TO   CITY   HOMES  30I 

TABLE  XX. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Male  Dependents  Admitted  in  May,  igia: 

for  Those  Found,  After  Investigation,  to  Fall  into  the  Groups  Shown;  and  for  Those 

Who   Could  Not  be  Classified,  but   Who   Would  Have  Fallen  into   These 

GroupsontheBasisoftheProportionsinEach  Group  of  Those  Classified. 

— ' 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     I $5,774.30 

Group    II 2,404.78 

Group  III 739.00 

Total $8,918.08 


LIST   I. 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division. 

Readmissions  of  Dependents  Discharged  from  This  Home  for  Transfer  to  New  York  City 

Farm  Colony,  the  Discharges  Having  Taken  Place  from  January  i,  igio,  to 

June  30,  IQI2. 

Explanation  of  Abbreviations: 

B.D.A.  Bureau  of  Dependent  Adults,  Manhattan. 

F.C.  Discharged  for  transfer  to  Farm  Colony. 

Met.  Hosp.  Metropolitan  Hospital. 

State  Reg.  Entered  upon  the  State  Register  as  a  State  Poor  person. 

State  Agt.  Discharged  in  custody  of  Agent  of  the  State  Board  of  Charities. 

On  Reg.  Name  of  dependent  on  Register  at  this  Home. 

No.  of  Date  By  Whom  Date  of  Cause  of 

Case  Readmitted  Readmitted  Discharge  Discharge 

B.D.A.  Feb.  29,  1912  

B.D.A.  Apr.  22,  1912  

B.D.A.  July  15,  1912  

B.D.A.  On  Reg.  Jan.  1,  1913 

B.D.A.  Apr.  15,  1912  

B.D.A.  Dec.  29,  1911              Died 

City  Hosp.  On  Reg.  Jan.  1,  1913 

B.D.A.  On  Reg.  Jan.  1,  1913 

B.D.A.  May  28,  1912  


3 

Nov.  8,  1911 

4 

Aug.  17,  1911 

" 

June  25,  1912 

6 

May  11,  1912 

8 

Jan.  8,  1912 

9 

Dec.  11,  1911 

15 

June  24,  1912 

16 

June  10,  1912 

18 

May  16,  1912 

30i 


HCSPITAL   COMMITTEE 


No.  of 
Case 


'•"TDate 
Readmitted 


By  Whom 
Readmitted 


Date  of 
Discharge 


Cause  ol 
Discharge 


Mar.  25, 
May  7 
May  20, 
July  12: 
Apr.  12: 
Mar.  7 
June  6, 
July  17' 
June  13, 
June  26, 
Apr.  22: 
May  31 
July  19^ 
June  13, 
June  20' 
July  S: 
June  20, 
Mar.  17 
Dec.  19, 
Mar.  14; 

July  8, 
Sept.  26 
Nov.  9: 
Apr.  27 
Dec.  3 
June  20, 
May  26 
Oct.  29, 
Nov.  4, 
Apr.  29. 
Apr.  22! 
July  15; 
Oct.  31 
Dec.  2S: 
June  12, 
Aug.  10 
Sept.  11 
Aug.  31 
Nov.  4 
July  18 
May  9 
June  11 
June  27 
Aug.  17 
Aug.  26, 
Sept. 
Oct.  18, 
Jan. 
Aug.  13 
Oct.  21, 
July  28; 
Sept.  16 
Aug.  12 
Oct.  IS 
June  26, 
Sept.  28, 
July  13, 
Aug.  17' 
Aug.  3 
July     2 


1912  B.D.A.  May    2 

1912  B.D.A.  May  17 

1912  B.D.A.  May  2i: 

1912  B.D.A.  On  Reg. 

1912  B.D.A.  Apr.  30 

1912  B.D.A.  June  18 

1912  B.D.A.  On  Reg. 

1912  B.D.A.  Aug.    8 

1912  B.D.A.  On  Reg. 

1912  B.D.A.  June  27 

1912  B.D.A.  On  Reg. 

1912  B.D.A.  June  17 

1912  B.D.A.  July  22 

1912  B.D.A.  On  Reg. 

1912  F.C.  June  21 

1912  B.D.A.  On  Reg. 

1912  F.C.  On  Reg. 

1911  B.D.A.  Nov.    4 

1910  B.D.A.  Dec.  20 

1911  Transferred  by  order  of    Apr.  14 

Dr.  Schultze 

1910  B.D.A.  Sept.  20 

1910  B.D.A.  Nov.    3 

1911  B.D.A.  On  Reg. 
1910  B.D.A.  May    6 

1910  B.D.A.  Dec.    & 

1911  B.D.A.  Oct.  11 
1910  B.D.A.  June  3 
1910  B.D.A.  Nov.  4 
1910  B.D.A.  Sept.  13 
1910  B.D.A.  May  2 
1910  B.D.A.  Aug.  16 
1910  B.D.A.  Aug.  31 
1910  B.D.A.  Dec.  12 

1910  B.D.A.  Feb.  14 

1911  B.D.A.  June  15 
1911  B.D.A.  Sept.  5 
1911  B.D.A.  Feb.  19 
1910  B.D.A.  Oct.  20 
1910  B.D.A.  Nov.  22 
1910  B.D.A.  July  25 
1910  B.D.A.  May  10 
1910  B.D.A.  June  13 
1910  B.D.A.  July  23 
1910  B.D.A.  Aug.  23 
1910  B.D.A.  Aug.  29 
1910  B.D.A.  Oct.   17 

1910  B.D.A.  Oct.  22 

1911  B.D.A.  Jan.  12 

1912  B.D.A.  Aug.  21 
1912  B.D.A.  Dec.  2 
1910  B.D.A.  Aug.  30 

1910  B.D.A.  May  5 

1911  B.D.A.  Aug.  21 

1911  B.D.A.  May  27 

1912  B.D.A.  Sept.  16 
1912  B.D.A.  On  Reg. 
1910  B.D.A.  Aug.  18, 
1910  B.D.A.  Oct.  7 
1910  B.D.A.  July  17 
1912  B.D.A.  On  Reg. 


1912  

1912  

1912  F.C. 

Jan.  1,  1913 

1912  F.C. 

1912  F.C. 

Jan.  1,  1913 

1912  F.C. 

Jan.  1,  1913 

1912  

Jan.  1,  1913 

1912  

1912  F.C. 

Jan.  1,  1913 

1912  

Jan.  1,  1913 

Jan.  1,  1913 

1912  To  pay  roll 

1910  F.C. 

1911  Died 

1910  

1910  

Dec.  2,  1912 

1910  F.C. 

1910  F.C. 

1911  F.C. 

1910  

1910  

1911  

1910  State  Reg. 

1911  Died 

1910  

1910  

1911  

1911  

1911  

1912  

1910  

1910  

1910  Died 

1910  Refused  to  work 

1910  Refused  to  work 

1910  

1910  

1910  Refused  to  work 

1910  

1910  

1911  F.C. 

1912  

1912  

1910  

1911  

1911  

1912  

1912  

Dec.  2,  1912 

1910  Died 

1910  Died 

1911  

Dec.  2,  1912 


ADMISSIONS   TO   CITY  HOMES 


303 


No.  of 

Date 

Case 

Readmitted 

253 

Aug.  11,  1910 

" 

Apr.  22 

1911 

" 

Oct.  2 

1911 

" 

June  5 

1912 

" 

Aug.  28 

1912 

254 

May  29 

1911 

" 

Sept.  13 

1912 

259 

Aug.  31 

1911 

" 

Aug.  29 

1912 

261 

July  6 

1910 

" 

July  9 

1910 

" 

Aug.  S 

1910 

" 

Oct.  10 

1910 

" 

July  10 

1911 

" 

Sept.  14 

1911 

" 

Jan.  25 

1912 

" 

May  13 

1912 

" 

Oct.  16 

1912 

263 

Feb.  23 

1911 

" 

July  31 

1911 

" 

Aug.  12 

1912 

267 

Dec.  14 

1911 

268 

July  26 

1910 

" 

July  28 

1911 

" 

Dec.  11 

1911 

271 

Aug.  23 

1910 

274 

July  3 

1912 

276 

July  1 

1911 

" 

June  13 

1912 

277 

July  2 

1912 

278 

Dec.  7 

1910 

281 

Sept.  9 

1911 

282 

Nov.  15 

1910 

284 

Apr.  18 

1911 

285 

Nov.  29 

1910 

288 

Mar.  8 

1912 

" 

Apr.  26 

1912 

290 

Dec.  22 

1910 

" 

May  8 

1911 

" 

Aug.  18 

1911 

291 

Oct.  5 

1911 

301 

Nov.  28 

1910 

" 

Dec.  16 

1911 

" 

Dec.  21 

1911 

304 

Jan.  3 

1911 

" 

June  22 

1911 

309 

Nov.  14 

1910 

313 

Nov.  15 

1911 

316 

Nov.  29 

1911 

" 

Oct.  29 

1912 

321 

Mar.  14 

1911 

" 

Mar.  24 

1911 

" 

Feb.  8 

1912 

323 

Dec.  27 

1911 

324 

Mar.  18 

,  1912 

325 

Nov.  29 

1911 

327 

Dec.  8 

1910 

329 

May  31 

1911 

336 

Oct.  E 

1911 

" 

Nov.  4 

,1912 

By  Whom 
Readmitted 


Date  of 
Discharge 


Cause  of 
Discharge 


B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

Met.  Hosp. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

Met.  Hosp. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A. 

B.D.A 

B.D.A. 

B.D.A. 


Oct.  4 
Aug.  10 
May  20, 
Aug. 
Nov.  20 
Sept.  £ 
On  Reg 
Mar.  16, 
Sept 
July 
July  20 
Oct.  7 
Nov.  10, 
Sept.  11 
Jan.  22 
May  10 
May  21 
On  Reg. 
July  24 
Aug.  5 
On  Reg. 
Dec.  19 
Apr.  26, 
Oct.  9 
Mar.  14 
Aug.  23 
July  22 
Nov.  27 
Sept.  19 
July  - 
Dec.  15 
June  18 
On  Reg. 
June  IS 
Dec.  7 
Mar.  20 
June  26 
May  8, 
June  29 
Sept.  12 
Aug.  8 
Nov.  29 
Dec.  26 
Dec.  27 
Jan.  14 
June  24 
June  29 
Nov.  1%. 
June  24 
On  Reg. 
Mar.  IS 
Aug.  17 
Mar.  19: 
Apr.  23 
Apr.  16 
Apr.  20 
Feb.  22 
June  1 
Feb.  29 
On  Reg 


,  1910  

,  1911  

,  1912  

,  1912  

',  1912  

,  1912  

Dec.  2,  1912 

,  1912  

,  1912  F.C. 

,  1910  

',  1910  

,  1910  

I  1910  F.C. 

,  1911  

,  1912  

I,  1912  

,  1912  F.C. 

Dec.  2,  1912 

,1911  ToCityHosp. 

',  1912  

.  Dec.  2,  1912 

,  1911  F.C. 

i,  1911  

,  1911  

,  1912  

,  1910  

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,  1911  

,  1912  

,  1912  

,  1910  

,  1912  

Dec.  2,  1912 

,  1912  F.C. 

,  1910  State  Agt. 

>,  1912  

,  1912  

,  1911  

,  1911  F.C. 

;,  1911  

,  1912  F.C. 

,  1910  F.C. 

i,  1911  

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:,  1911  

',  1911  F.C. 

,  1911  

,  1912  

Dec.  2,  1912 

,  1911  

,1911  

, 1912  

,,  1912  

,  1912  

,  1912  

,  1911  

,1911  

,  1912  F.C. 
.  Dec.  2,  1912 


304 


HOSPITAL   COMMITTEE 


No.  of 
Case 


Date 
Readmitted 


By  Whom 
Readmitted 


Date  of 
Discharge 


Cause  of 
Discharge 


338 

Jan.  12,  1911 

B.D.A. 

" 

Apr.  4,  1911 

B.D.A. 

" 

July  15,  1911 

B.D.A. 

339 

Jan.  11,  1912 

Met.  Hosp. 

340 

Feb.  23,  1912 

B.D.A. 

353 

May  16,  1912 

F.C. 

363 

May  11,  1911 

B.D.A. 

364 

Apr.  3,  1911 

B.D.A. 

370 

Jan.  3,  1911 

B.D.A. 

382 

June  6,  1911 

B.D.A. 

387 

July  21,  1911 

B.D.A. 

Oct.  20,  1911 

B.D.A. 

388 

Jan.  6,  1912 

B.D.A. 

390 

Jan.  16,  1912 

B.D.A. 

Apr.  23,  1912 

Bellevue  Hosp 

" 

Nov.  4,  1912 

B.D.A. 

" 

Nov.  19,  1912 

B.D.A. 

397 

Apr.  3,  1911 

B.D.A. 

" 

May  8,  1911 

B.D.A. 

" 

May  29,  1911 

B.D.A. 

400 

Aug.  10,  1911 

B.D.A. 

401 

Apr.  4,1911 

B.D.A. 

" 

Jan.  29,  1912 

B.D.A. 

407 

Sept.  12,  1911 

B.D.A. 

" 

Aug.  12,  1912 

B.D.A. 

" 

Oct.  14,  1912 

B.D.A. 

410 

Nov.  25,  1911 

B.D.A. 

" 

June  18,  1912 

B.D.A. 

425 

Aug.  4,  1911 

B.D.A. 

429 

Dec.  28,  1911 

B.D.A. 

437  • 

Jan.  20,  1912 

B.D.A. 

444 

Sept.  6,  1911 

B.D.A. 

" 

Aug.  22,  1912 

B.D.A. 

448 

Oct.  31,  1911 

B.D.A. 

" 

May  2,  1912 

B.D.A. 

449 

Nov.  27,  1911 

B.D.A. 

450 

Nov.  27,  1911 

B.D.A. 

" 

July  25,  1912 

B.D.A. 

452 

Nov.  14,  1911 

B.D.A. 

455 

Nov.  16,  1911 

B.D.A. 

July  9,  1912 

B.D.A. 

458 

Dec.  4,  1911 

B.D.A. 

466 

Jan.  10,  1912 

B.D.A. 

473 

July  6,  1912 

B.D.A. 

478 

Sept.  14,  1911 

B.D.A. 

481 

July  1,  1912 

B.D.A. 

494 

Apr.  4,  1912 

B.D.A. 

501 

Nov.  26,  1912 

F.C. 

502 

July  18,  1911 

B.D.A. 

Mar.  20,  1911       

Apr.  25,  1911      

Aug.  7,  1911      

Apr.  22,  1912      

Sept.  26,  1912      

On  Reg.  Dec.  2,  1912 
July  3,  1911      Died 
On  Reg.  Dec.  2,  1912 

June  12,  1911      

June  S,  1911      F.C. 

Oct.  9,  1911      

Apr.  22,  1912      

Apr.  19,  1912      

Apr.  11,  1912      

May  3,  1912      

Nov.  18,  1912      

On  Reg.  Dec.  2,  1912 

Apr.  20,  1911       

May  23,  1911      

June  13,  1911       

Sept.  5,  1912      F.C. 

July  11,  1911      

Apr.  11,  1912      

May  14,  1912      

Sept.  16,  1912      

On  Reg.  Dec.  2,  1912 

Dec.  23,  1911      

On  Reg.  Dec.  2,  1912 

Aug.  8,  1911      

Apr.  23,  1912      F.C. 
On  Reg.  Dec.  20,  1912 

Aug.  13,  1912      

On  Reg.  Dec.  2,  1912 

Nov.  3,  1911      

On  Reg.  Dec.  2,  1912 
On  Reg.  Dec.  2,  1912 

July  24,  1912      

On  Reg.  Dec.  2,  1912 
May  10,  1912      Died 

May  20,  1912      

Nov.  6,  1912      

Apr.  23,  1912      

On  Reg.  Dec.  2,  1912 
On  Reg.  Dec.  2,  1912 
Feb.  IS,  1912  Died 
On  Reg.  Dec.  2,  1912 
Apr.  26,  1912  Died 
On  Reg.  Dec.  2,  1912 
On  Reg.  Dec.  2,  1912 


ADMISSIONS  TO  CITY  HOMES 


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305 


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HOSPITAL  COMMITTEE 


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ADMISSIONS   TO   CITY  HOMES  307 

TABLE  XXIII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Authorizations  for  Admission  Found  on  File  at  the  Home  for  the  241  Admissions  in  May,  ipis. 

Admissions  Having  Authorizations  at  the  Home  from  the  Bureau  of 

Dependent  Adults 182 

Permits  bearing  the  name  of  a  clerk  in  the  Bureau  of  Dependent 
Adults 182 

Admissions   Not  Having  Authorizations  at  the  Home  from  the 
Bureau  of  Dependent  Adults 59 

Transfer  slips  bearing  the  name  of  the  Superintendent  of  Kings 

County  Hospital 56 

Admissions  entered  on  the  daUy  admission  reports  for  which  there 
were  no  permits  or  transfer  slips  found  on  file  and  no  entries 
on  the  alphabetical  register  at  the  Home 2 

Admissions  for  which  there  were  no  entries  on  the  daUy  admission 
reports,  no  permits  or  transfer  sUps  found  on  file,  and  no  entries 
on  the  alphabetical  register 1 

59 

Total 241 


ANALYSIS  OF  THE  977  DISCHARGES  FROM  NEW  YORK  CITY  HOME  FOR 

THE  AGED  AND  INFIRM,  BROOKLYN  DIVISION,  FOR  TRANSFER  TO 

NEW    YORK    CITY    FARM    COLONY,    FROM    JANUARY    1,    1909, 

TO  AUGUST  1,  1912;  THEIR  DISPOSAL  AT  FARM  COLONY; 

AND    THEIR  READMISSION  TO  THE  CITY   HOME. 


SUMMARY  NO.  II. 
First  Discharge 

I.  Process  of  Transfer 

Dependents  discharged  first  time  for  transfer 869 

Dependents  who  failed  to  arrive  at  Farm  Colony 88 

Dependents  who  arrived  at  Farm  Colony 781 

869 

II.  Disposal  at  Farm  Colony 

Dependents  received  on  first  transfer 781 

Dependents  remaining  at  Farm  Colony  in  August,  1912 260 

Dependents  who  died  at  Farm  Colony 56 

Dependents  retransf erred  to  other  institutions 38 

Dependents  who  left  Farm  Colony  without  transfer  or  death. . . .  427 

781 
Dependents  who  left  Farm  Colony  without  transfer  or  death . . .  427 

III.  Dependents   Readmitted    to    City     Home    After    First 

Discharge 169 


oo8  HOSPITAL  COMMITTEE 

Second  Discharge 

I.  Process  of  Transfer 

Dependents  discharged  second  time  for  transfer 

Dependents  who  failed  to  arrive  at  Farm  Colony 16 

Dependents  who  arrived  at  Farm  Colony 67 

82 

II.  Disposal  at  Farm  CoLO>fY 

Dependents  received  on  second  transfer 

Dependents  remaining  at  Farm  Colony  in  August,  1912 19 

Dependents  who  died  at  Farm  Colony 1 

Dependents  retransferred  to  other  institutions 1 

Dependents  who  left  Farm  Colony  without  transfer  or  death. . .  46 

67 

Dependents  who  left  Farm  Colony  without  transfer  or  death. . . 

III.  Dependents    Readmitted   to   City    Home    After    Second 

Discharge 

Third  Discharge 

I.  Process  of  Transfer 

Dependents  discharged  third  time  for  transfer 

Dependents  who  failed  to  arrive  at  Farm  Colony 4 

Dependents  who  arrived  at  Farm  Colony 14 

18 

II.  Disposal  at  Farm  Colony 

Dependents  received  on  third  transfer 

Dependents  remaining  at  Farm  Colony  in  August,  1912 4 

Dependents  who  left  Farm  Colony  without  transfer  or  death. . .         10 

14 

Dependents  who  left  Farm  Colony  without  transfer  or  death. . . 

III.  Dependents    Readmitted    to    City    Home    After    Third 

Discharge 

Fourth  Discharge 

I.  Process  of  Transfer 

Dependents  discharged  fourth  time  for  transfer 

Dependents  who  arrived  at  Farm  Colony 8 

II.  Disposal  at  Farm  Colony 

Dependents  received  on  fourth  transfer 

Dependents  remaining  at  Farm  Colony  in  August,  1912 2 

Dependents  who  died  at  Farm  Colony 1 

Dependents  who  left  Farm  Colony  without  transfer  or  death. . .  5 

8 
Dependents  who  left  Farm  Colony  without  transfer  or  death. . . 

III.  Dependents    Readmitted    to   City    Home   After    Fourth 

Discharge 

Fijtii  Discharge 

Dependents  discharged  fifth  time  for  transfer 


82 


67 


46 


28 


10 


ADMISSIONS   TO   CITY  HOMES 


309 


TABLE  XXIV. 
Rearrangement  of  Summary  No.  II,  with  Totals  Added. 


Process  of  Transfer 

Disposal  at 

Farm  Colony 

Read- 

Failed 

Transfers 

All 

mitted 

Total 

to 

Arrived  Remain- 

Died 

from 

Others 

to 

Dis- 

Arrive 

at 

ing  at 

at 

F.  C.  to 

Leav- 

City 

charged 

at 

F.  C. 

F.  C. 

F.  C. 

Other 

T,™I 

Home 

F.  C. 

Inst'ns 

F.  C. 

First  Discharge.. 

869 

88 

781 

260 

56 

38 

427 

Readmitted 

169 

Second  Discharge 

82 

15 

67 

19 

i 

i 

46 

Readmitted 

28 

Third  Discharge. . 

18 

4 

14 

4 

io 

Readmitted 

a 

Fourth  Discharge 

8 

8 

2 

i 

5 

Readnutted 

2 

Total 

210 

977 

107 

870 

285 

58 

39 

488 

TABLE  XXV. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Dependents  Readmitted  After  Their  First  Discharge  from  the  Home,  between  January  I, 
igop,  and  August  i,  1912,  for  Transfer  to  New  York  City  Farm  Colony. 


Reasons  for  Leaving 
Farm  Colony 

Failed  to  arrive  at  Farm 

Colony 6 

Absconded 121 

By  own  request 19 

Overstayed  Passes 7 

Transferred  to  Metropoh- 

tan  Hospital 1 

Discharged  by  order  of 

the  Superintendent 4 

Unexplained 11 

Total 169 


Means  of  Readmission 
TO  the  Home 

Office  of  Second  Deputy 
Commissioner  of  Char- 
ities   158 

Transferred  from  Kings 
County  Hospital 11 


Total. 169 


Disposition  at  the 
Home 

Died 3 

Discharged  for  refusing 
transfer  to  Farm  Col- 
ony       6 

Absconded 4 

Discharged  at  own  re- 
quest   80 

Sent  to  Bureau  of  Depen- 
dent Adults,  Brooklyn.     4 

Transferred  to  Kings 
County  Hospital 1 

Transferred  to  Farm 
Colony 60 

Remaining  in  the  Home 
August,  1912 11 

Total 169 


310 


HOSPITAL   COMMITTEE 


TABLE  XXVI. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Dependents  Readmitted  After  Their  Second  Discharge  from  the  Home,  between  January  I, 
ic}OQ,  and  August  i,  1012,  for  Transfer  to  New  York  City  Farm  Colony. 


Reasons  for  Leaving 
Farm  Colony 

Failed  to  arrive  at  Farm 

Colony 6 

Absconded 15 

By  own  request 2 

Overstayed  Passes 1 

Discharged  by  order  of 

Superintendent 1 

Entered  on  Farm  Colony 
discharge  book  as  not 

discharged 1 

Unexplained 2 

Total 28 


Means  of  Readmission  Disposition  at  the 

TO  the  Home  Home 

Office  of  Second  Deputy          Discharged   at   own    re- 
Commissioner  of  Char-  quest 14 

ities 2S     Discharged   for   refusing 

transfer  to  Farm  Col- 
ony      4 

Transferred  to  Farm  Col- 
ony   10 

Total 28  Total 28 


TABLE  XXVII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Discharges  of  Dependents  for  Refusing  to  be  Transferred  to  New  York  City  Farm  Colony, 
Their  Readmissions,  and  Their  Disposal  After  Readmissions. 


Discharged 
Readmit-  Remaining    Died  at  Transferred  Discharged,       for 

ted  to         in  City  City         to  Farm       Miscel-       Refusing 

City  Home     Home  Home         Colony       laneous         Farm 

Colony 


First  Discharge 

Readmitted 

"ii 

Second  Discharge 

Readmitted 

'"e         '. 

Third  Discharge 

Readmitted 

"'2 

Fourth  Discharge. . . . 

"i 

Fifth  Discharge 

Readmitted 

"i         '. 

Sixth  Discharge 

Total 

57 

178 


ADMISSIONS   TO   CITY   HOMES  3II 

TABLE  XXVIII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Dependents  Readmitted  After  Their  First  Discharge  from  the  Home,  between  January  i,  iQlo, 
and  A  ugust  i,  igi2,  for  Refusing  Transfer  to  New  York  City  Farm  Colony. 

* 

Means  of  Readmission  to  the  Home  Disposition  at  the  Home 

Bureau  of  Dependent  Adults 39      Absconded 2 

Kings  County  Hospital 8      Refused  transfer  to  Farm  Colony 6 

Discharged  at  own  request 14 

Transferred  to  Farm  Colony 8 

Remaining  in   Home   December,    1912  14 
Transferred  to  Ward  33,  Kings  County 

Hospital 1 

Died 1 

Sent  to  Bureau  of  Dependent  Adults. .     1 

Total 47  Total 47 


TABLE  XXIX. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  2j6  Dependents  Entered 
upon  the  Records  of  Admission  to  the  Home  in  May,  iqi2. 

.1 

Residences  of  dependents  just  prior  to  admission 76,  or  32.2% 

Residences  of  dependents  at  some  time  before  admission 22,  "     9.3% 

Addresses  where  dependents  were  not  known 58,  "  24.6% 

Addresses  of  lodging  houses 24,  "  10 . 2% 

Addresses  that  were  not  residential 22,  "     9.3% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 4,  "     1.7% 

Dependents  admitted  without  residential  addresses 30,  "  12.7% 

236,  or  100.0% 


TABLE  XXX. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  IQ4  Relatives  and  Friends 
of  Dependents  Entered  Upon  the  Records  of  Admission  in  May,  IQ12. 

Residences  of  relatives  or  friends  just  prior  to  the  admission 122,  or  62.9% 

Residences  of  relatives  or  friends  at  some  time  before  the  admission 6,  "  3.1% 

Addresses  where  relatives  or  friends  were  not  known 36,  "  18.6% 

Addresses  of  lodging  houses 2,  "  1.0% 

Addresses  that  were  not  residential 13,  "  6.7% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 9,  "  4.6% 

Addresses  that  were  outside  of  the  City 6,  "  3.1% 

194,orl00.0% 

Note:     The  records  for  36  admissions  during  this  month  had  no  names  and  addresses 
of  relatives  or  friends  entered  upon  them. 


312  HOSPITAL   COMMITTEE 

TABLE  XXXI. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Findings,  After  Investigation,  Regarding  the  Character  of  the  241  Dependents  Admitted  in 

May,  IQI2. 

Admissions  That  Could  Not  be  Classified  as  to  Character  for  the 

Following  Reasons:  114 

The  addresses  found  at  the  Home  were  insufBcient  in 10  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 78      " 

The  addresses  given  were  too  old  in 12      " 

SufiSciently  complete  histories  could  not  be  secured  in 14      " 

114  Cases 
Admissions  Classified  as  to  Character:  127 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon 

the  City's  support 88,  or  69.3% 

Dependents  who  were  aliens 4,  "     3.1% 

Dependents  who  did  not  have  a  legal  settlement  in  New  York  City       1,   "       .8% 
Dependents  who  had  legally  responsible  relatives  able  to  pay  for 

their  maintenance 16,   "  12.6% 

Dependents  who  were  personally  able  to  pay  for  their  maintenance     2,  "     1.6% 
Dependents  who  were  wives  or  children  of  men  who  had  served  in 

the  U.  S.  Army  or  Navy 1,  "       .8% 

Dependents  who  had  relatives  or  friends  willing  to  support  them 

in  their  own  homes 9,  "     7.1% 

Dependents  who  had  relatives  not  legally  responsible  but  able 

to  pay  for  their  maintenance 2,   "     1.6% 

Dependents  who  were  able  to  work  to  earn  their  own  support .       4,   "     3.1% 

127,  or  100.0% 
Total 241 


TABLE  XXXII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Dependents  Admitted  in  May,  iQii, 
and  Found,  After  Investigation,  to  Fall  Into  Certain  Groups. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 
Dependents  who  were  personally  able  to  pay  for  their  maintenance. 
Dependents  who  were  aliens. 
Dependents  who  were  non-residents  of  the  city. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homea. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     I $766.00 

Group   II 42.77 

Group  III 706.47 

Total 81,515.24 


ADMISSIONS   TO   CITY  HOMES  313 

TABLE  XXXIII. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Dependents  Admitted  in  May,  1912: 

for  Those  Found,  After  Investigation,  to  Fall  into  the  Groups  Shown;  and  for  Those 

Who  Could  Not  be  Classified,  but  Who  Would  Have  Fallen  into  These  Groups 

on  the  Basis  of  the  Proportions  in  Each  Group  of  Those  Classified. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 
Dependents  who  were  personally  able  to  pay  for  their  maintenance. 
Dependents  who  were  aliens. 
Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     I Sl,619.44 

Group    II 90.42 

Group  III 1,493.59 

Total $3,203.45 


LIST   II. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Readmissions  Within  11  Months  after  the  Date  of  the  Letter  of  the  Second  Deputy  Commissioner 

of  Public  Charities  [see  page  35)  of  Dependents  Discharged  from 

the  Home  for   Transfer  to  New 

York  City  Farm  Colony. 

Explanation  of  Abbrevlations: 

C.  of  C.  Deputy  Commissioner  of  Charities'  Office  in  Brooklyn. 

Hosp.  Kings  County  Hospital. 

F.C.  Discharged  for  transfer  to  Farm  Colony. 

Ref.  F.C.  Discharged  for  refusing  transfer  to  Farm  Colony. 

On  Reg.  Name  of  dependent  on  Register  at  this  Home. 

Own  Req.     Discharge  requested  by  dependent. 


No.  of 

Date 

By  Whom 

Date  of 

Cause  of 

Case 

Readmitted 

Readmitted 

Discharge 

Discharge 

2 

May  13,  1912 

C.  of  C. 

May  25,  1912 

Own  Req. 

56 

July  15,  1912 

C.  of  C. 

July  16,  1912 

Ref.  F.C. 

58 

Oct.   19,  1911 

C.  of  C. 

Oct.  24,  1911 

F.C. 

61 

Dec.  28,  1911 

C.  of  C. 

Jan.     4,  1912 

F.C. 

66 

Oct.   10,  1911 

C.  of  C. 

Oct.   13,  1911 

F.C. 

69 

Jan.   20,  1912 

C.  of  C. 

June  10,  1912 

Own  Req. 

116 

Dec.  22,  1911 

C.  of  C. 

Jan.     9,  1912 

Own  Req. 

128 

Nov.  18,  1911 

C.  of  C. 

Nov.  20,  1911 

To  C.  of  C. 

" 

Aug.    5,  1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

141 

Apr.     6,  1912 

C.  of  C. 

May  21,  1912 

F.C. 

163 

May  10,  1912 

C.  of  C. 

May  20,  1912 

Own  Req. 

169 

Dec.  19,  1911 

C.  of  C. 

Dec.  21,  1911 

F.C. 

174 

Apr.  25,  1912 

C.  of  C. 

Apr.     1,  1912 

Own  Req. 

314 


HOSPITAL    COMMITTEE 


No.  of 

Date 

By  Whom 

Date  of 

Cause  of 

Case 

Readmitted 

Readmitted 

Discharge 

Discharge 

177 

Aug.  13,  1912 

C.  of  C. 

Aug.  15,  1912 

F.C. 

179 

Nov.  IS 

1911 

C.  of  C. 

Nov.  20,  1911 

To  C.  of  C. 

182 

Dec.     1 

1911 

C.  of  C. 

Dec.  12,  1911 

F.C. 

" 

Dec.  20 

1911 

C.  of  C. 

Dec.  21,  1911 

Ref.  F.C. 

" 

Dec.  28 

1911 

C.  of  C. 

Dec.  29,  1911 

To  C.  of  C. 

" 

Jan.     3 

1912 

C.  of  C. 

Jan.   11,  1912 

F.C. 

" 

Mar.  23 

1912 

C.  of  C. 

May  21,  1912 

Ref.  F.C. 

" 

July  19 

1912 

C.  of  C. 

July  24,  1912 

Absconded 

" 

Aug.    7 

1912 

C.  of  C. 

Aug.  15,  1912 

Ref.  F.C. 

187 

Feb.     1 

1912 

C.  of  C. 

Apr.     4,  1912 

Own  Req. 

198 

Mar.  31 

1912 

C.  of  C. 

Apr.  26,  1912 

Own  Req. 

" 

May  30 

1912 

C.  of  C. 

June    3,  1912 

Own  Req. 

" 

June  12 

1912 

C.  of  C. 

June  17,  1912 

Absconded 

209 

Apr.  15 

1912 

C.  of  C. 

May  21,  1912 

F.C. 

226 

Feb.  14 

1912 

C.  of  C. 

Dec.  19,  1912 

Own  Req. 

249 

Aug.  28 

1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

259 

Nov.  27 

1911 

C.  of  C. 

Nov.  28,  1911 

F.C. 

262 

Dec.     6 

1911 

C.  of  C. 

Dec.    7,  1911 

Own  Req. 

" 

Feb.  19 

1912 

C.  of  C. 

Feb.  21,  1912 

Own  Req. 

" 

Mar.  15 

1912 

C.  of  C. 

July  22,  1912 

Own  Req. 

" 

July  24 

1912 

C.  of  C. 

July  25,  1912 

F.C. 

" 

July  29 

1912 

C.  of  C. 

July  31,  1912 

Ref.  F.C. 

" 

Aug.    5 

1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

270 

Apr.  14 

1912 

C.  of  C. 

July  24,  1912 

Ref.  F.C. 

" 

July  29 

1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

272 

Jan.     8 

1912 

C.  of  C. 

Apr.     8,  1912 

Own  Req. 

" 

June  11 

1912 

C.  of  C. 

On  Reg.  Nov.  25 

1912 

289 

Dec.  15 

1911 

C.  of  C. 

Dec.  21,  1911 

F.C. 

" 

Feb.  14 

1912 

C.  of  C. 

May    2,  1912 

Own  Req. 

" 

May  21 

1912 

C.  of  C. 

June  20,  1912 

Own  Req. 

" 

July  19 

1912 

C.  of  C. 

Aug.    6,  1912 

Own  Req. 

" 

Aug.  14 

1912 

C.  of  C. 

Aug.  15,  1912 

Ref.  F.C. 

290 

Nov.    9 

1911 

C.  of  C. 

Nov.  22,  1911 

Own  Req. 

" 

Jan.   17 

1912 

C.  of  C. 

Mar.  IS,  1912 

Own  Req. 

" 

Mar.  25 

1912 

C.  of  C. 

June    5,  1912 

Own  Req. 

" 

June  10 

1912 

C.  of  C. 

July     1,  1912 

Own  Req. 

291 

Nov.    9 

1911 

C.  of  C. 

Dec.    4,  1911 

Own  Req. 

" 

Mar.    7 

1912 

C.  of  C. 

Mar.  IS,  1912 

Own  Req. 

" 

Apr.  31 

1912 

C.  of  C. 

May  27,  1912 

Own  Req. 

" 

June    2 

1912 

C.  of  C. 

June    8,  1912 

Own  Req. 

" 

June  10 

1912 

C.  of  C. 

June  17,  1912 

Own  Req. 

293 

Nov.  21 

1911 

C.  of  C. 

Nov.  28,  1911 

F.C. 

" 

Jan.     9 

1912 

Hosp. 

Jan.   11,  1912 

F.C. 

294 

Oct.    16 

1911 

Hosp. 

Oct.  24,  1911 

F.C. 

301 

Aug.    8 

1912 

C.  of  C. 

Aug.    8,  1912 

Own  Req. 

307 

Feb.  29 

1912 

C.  of  C. 

Mar.    2,  1912 

Died 

316 

May    6 

1912 

C.  of  C. 

May  20,  1912 

Own  Req. 

317 

Nov.  21 

1911 

C.  of  C. 

Nov.  28,  1911 

F.C. 

322 

July  15 

1912 

C.  of  C. 

July  16,  1912 

F.C. 

330 

Jan.   18 

1912 

C.  of  C. 

July  16,  1912 

F.C. 

338 

Mar.  20 

1912 

C.  of  C. 

July  22,  1912 

Own  Req. 

351 

May  15 

1912 

C.  of  C. 

Aug.  21,  1912 

F.C. 

354 

Oct.   19 

1911 

C.  of  C. 

Feb.  19,  1912 

Own  Req. 

" 

Feb.  20 

1912 

C.  of  C. 

Apr.  19,  1912 

Own  Req. 

" 

May    3 

1912 

C.  of  C. 

May  27,  1912 

Own  Req. 

" 

May  31 

1912 

C.  of  C. 

July     2,  1912 

Own  Req. 

** 

July     5 

1912 

C.  of  C. 

Aug.  12,  1912 

Own  Req. 

" 

Aug.  19 

1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

356 

Nov.  11 

1911 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

369 

Nov.  20 

1911 

C.  of  C. 

May    6,  1912 

Own  Req. 

" 

May  30 

1912 

C.  of  C. 

July  16,  1912 

F.C. 

ADMISSIONS   TO   CITY  HOMES 


315 


No.  of 

Date 

By  Whom 

Date  of 

Cause  of 

Case 

Readmitted 

Readmitted 

Discharge 

Discharge 

373 

Oct.  20,  1911 

C.  of  C. 

Oct.   23,  1911 

Own  Req. 

381 

Dec.     2 

1911 

C.  of  C. 

Dec.  12 

1911 

F.C. 

397 

June  18 

1912 

C.  of  C. 

June  21 

1912 

Own  Req. 

416 

July  11 

1912 

C.  of  C. 

July  16 

1912 

F.C. 

435 

Nov.  25 

1911 

C.  of  C. 

Feb.     4 

1912 

Own  Req. 

439 

July  31 

1912 

C.  of  C. 

Aug.  15 

1912 

F.C. 

442 

Apr.     8 

1912 

C.  of  C. 

May  21 

1912 

F.C. 

446 

Nov.  21 

1911 

C.  of  C. 

Nov.  23 

1911 

Ref.  F.C. 

" 

Apr.     5 

1912 

C.  of  C. 

Apr.  26 

1912 

Own  Req. 

450 

Dec.    4 

1911 

C.  of  C. 

Dec.  12 

1911 

F.C. 

482 

Nov.    4 

1911 

C.  of  C. 

Nov.    9 

1911 

F.C. 

483 

Nov.  17 

1911 

C.  of  C. 

Jan.     1 

1912 

F.C. 

499 

July  24 

1912 

C.  of  C. 

July  25 

1912 

Ref.  F.C. 

503 

Mar.  20 

1912 

C.  of  C. 

Mar.  31 

1912 

Absconded 

" 

Aug.    9 

1912 

C.  of  C. 

Aug.  15 

1912 

F.C. 

539 

Dec.     1 

1911 

C.  of  C. 

Apr.     8 

1912 

Own  Req. 

541 

Dec.  30 

1911 

Hosp. 

Jan.   11 

1912 

F.C. 

545 

Nov.  20 

1911 

C.  of  C. 

Nov.  28 

1911 

F.C. 

546 

Nov.  22 

1911 

C.  of  C. 

Nov.  28 

1911 

F.C. 

" 

Apr.  15 

1912 

C.  of  C. 

May  13 

1912 

Own  Req. 

547 

Nov.  14 

1911 

C.  of  C. 

Nov.  16 

1911 

F.C. 

549 

Dec.  20 

1911 

C.  of  C. 

Dec.  21 

1911 

Ref.  F.C. 

654 

Dec.    8 

1911 

C.  of  C. 

Dec.  12 

1911 

F.C. 

561 

Dec.  21 

1911 

C.  of  C. 

Dec.  22 

1911 

Own  Req. 

571 

Jan.     2 

1912 

C.  of  C. 

Jan.     4 

1912 

F.C. 

585 

May    3 

1912 

C.  of  C. 

May  22 

1912 

Own  Req. 

" 

June  12 

1912 

C.  of  C. 

July     1 

1912 

Own  Req. 

590 

May  30 

1912 

C.  of  C. 

June    3 

1912 

Own  Req. 

602 

May    3 

1912 

C.  of  C. 

May    6 

1912 

Own  Req. 

" 

May    7 

1912 

C.  of  C. 

May  21 

1912 

F.C. 

605 

May  27 

1912 

C.  of  C. 

June  24 

1912 

Own  Req. 

636 

May  27 

1912 

C.  of  C. 

Aug.  19 

1912 

Died 

647 

Dec.  28 

1911 

C.  of  C. 

Dec.  28 

1911 

To  C.  of  C. 

" 

May  11 

1912 

C.  of  C. 

May  25 

1912 

Own  Req. 

" 

May  28 

1912 

C.  of  C. 

June    3 

1912 

Own  Req. 

" 

June    5 

1912 

C.  of  C. 

June    8 

1912 

Own  Req. 

" 

June  21 

1912 

C.  of  C. 

June  21 

1912 

Own  Req. 

660 

Oct.   11 

1911 

C.  of  C. 

Oct.   13 

1911 

Ref.  F.C. 

" 

Apr.  18 

1912 

C.  of  C. 

May  10 

1912 

Own  Req. 

" 

July  16 

1912 

C.  of  C. 

July  17 

1912 

Own  Req. 

701 

Aug.  16 

1912 

C.  of  C. 

On  Reg. 

Nov.  25, 

1912 

713 

Mar.  25 

1912 

C.  of  C. 

Apr.  22 

1912 

Own  Req. 

719 

Mar.  20 

1912 

C.  of  C. 

Apr.     1 

1912 

Own  Req. 

'* 

May  24 

1912 

C.  of  C. 

June  10 

1912 

Own  Req. 

** 

June  19 

1912 

C.  of  C. 

July  15 

1912 

Ref.  F.C. 

" 

July  20 

1912 

C.  of  C. 

Aug.  12 

1912 

Own  Req. 

" 

Aug.  16 

1912 

C.  of  C. 

Aug.  19 

1912 

Ref.  F.C. 

722 

Aug.  16 

1912 

C.  of  C. 

Aug.  19 

1912 

Own  Req. 

732 

Nov.    5 

1911 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

734 

Mar.  20 

1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

753 

Mar.  19 

1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

772 

Nov.  13 

1911 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

773 

July     5 

1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

775 

May  25 

1912 

C.  of  C. 

June    3,  1912 

Own  Req. 

" 

July     6 

1912 

C.  of  C. 

July  15,  1912 

Own  Req. 

** 

Aug.    6 

1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

776 

Oct.  28 

1911 

C.  of  C. 

Mar.  27,  1912 

Own  Req. 

781 

July  20 

1912 

C.  of  C. 

July  22,  1912 

Own  Req. 

821 

June  20 

1912 

C.  of  C. 

July  16,  1912 

F.C. 

822 

Jan.   29 

1912 

C.  of  C. 

Feb.  27,  1912 

Own  Req. 

May    4 

1912 

C.  of  C. 

May  21,  1912 

F.C. 

3i6 


HOSPITAL   COMMITTEE 


No.  of 

Date 

By  Whom 

Date  of 

Cause  of 

Case 

Readmitted 

Readmitted 

Discharge 

Discharge 

828 

Oct.   30,  1911 

C.  of  C. 

Oct.  31,  1911 

To  C.  of  C. 

841 

Nov.  15,  1911- 

C.  of  C. 

Nov.  16,  1911 

Own  Req. 

" 

May  23,  1912 

C.  of  C. 

June  10,  1912 

Own  Req. 

856 

Apr.     4,1912 

C.  of  C. 

Apr.     S,  1912 

Own  Req. 

875 

Feb.  20,  1912 

C.  of  C. 

Feb.  21,  1912 

To  C.  of  C. 

" 

May  20,  1912 

C.  of  C. 

June  11,  1912 

Own  Req. 

885 

Feb.  29,  1912 

C.  of  C. 

June  10,  1912 

Own  Req. 

" 

July  18,  1912 

C.  of  C. 

July  24,  1912 

Ref.  F.C. 

896 

Dec.  30,  1911 

C.  of  C. 

Jan.     4,  1912 

F.C. 

915 

Apr.  26,  1912 

C.  of  C. 

May    2,  1912 

Own  Req. 

" 

June  21,  1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

919 

June  24,  1912 

C.  of  C. 

June  24,  1912 

To  C.  of  C. 

923 

Nov.  11,  1911 

C.  of  C. 

Dec.  22,  1911 

Own  Req. 

925 

June  20,  1912 

C.  of  C. 

June  28,  1912 

Own  Req. 

" 

July     8,  1912 

C.  of  C. 

July  16  1912 

Ref.  F.C. 

926 

June  26,  1912 

C.  of  C. 

July     8'  1912 

Own  Req. 

927 

Aug.    6,  1912 

C.  of  C. 

Aug.    7,1912 

Own  Req. 

928 

July  23,  1912 

C.  of  C. 

July  25, 1912 

F.C. 

930 

Mar.  14,  1912 

C.  of  C. 

Apr.  24, 1912 

Own  Req. 

951 

Aug.  26,  1912 

C.  of  C. 

Sept.  12, 1912 

F.C. 

959 

Mar.  11,  1912 

C.  of  C. 

Mar.  17, 1912 

Own  Req. 

962 

Dec.    4,  1911 

C.  of  C. 

Dec.  21, 1911 

F.C. 

963 

Nov.    3,  1911 

C.  of  C. 

Nov.    9,  1911 

F.C. 

LIST  III. 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division. 

Readmissions  of  Dependents  Discharged  for  Refusing  Transfer  to  Farm  Colony 
after  October  J,  igii. 

Explanation  of  Abbreviations: 

C.  of  C.  Deputy  Commissioner  of  Charities'  Office  in  Brooklyn. 

Hosp.  Kings  County  Hospital. 

F.C.  Discharged  for  transfer  to  Farm  Colony. 

Ref.  F.C.  Discharged  for  refusing  transfer  to  Farm  Colony. 

On  Reg.  Name  of  dependent  on  Register  at  this  Home. 

Own  Req.  Discharge  requested  by  dependent. 


No.  of 

Date 

By  Whom 

Date  of 

Cause  of 

Case 

Readmitted 

Readmitted 

Discharge 

Discharge 

3 

Oct.  28,  1911 

C.  of  C. 

Dec.  21,  1911 

Ref.  F.C. 

" 

May  30,  1912 

Hosp. 

July  17,  1912 

Absconded 

" 

July  20,  1912 

C.  of  C. 

July  26,  1912 

Absconded 

" 

July  26,  1912 

C.  of  C. 

Aug.    1,  1912 

Absconded 

" 

Aug.    3,  1912 

C.  of  C. 

On  Reg.  Nov.  25 

1912 

7 

June  21,  1912 

C.  of  C. 

June  28,  1912 

Own  Req. 

" 

July     8,  1912 

C.  of  C. 

July  16,  1912 

Ref.  F.C. 

8 

Oct.  23,1911 

C.  of  C. 

Oct.  24,  1911 

F.C. 

" 

Nov.  16, 1911 

C.  of  C. 

Nov.  17,  1911 

To  C.  of  C. 

" 

Dec.    6,  1911 

C.  of  C. 

Dec.    7,  1911 

Own  Req. 

" 

Feb.  19,  1912 

Hosp. 

Feb.  21,  1912 

Own  Req. 

" 

Mar.  15,  1912 

C.  of  C. 

July  22,  1912 

Own  Req. 

" 

July  24,  1912 

C.  of  C. 

July  25,  1912 

F.C. 

" 

July  29,  1912 

C.  of  C. 

July  31,  1912 

Ref.  F.C. 

" 

Aug.    5,  1912 

C.  of  C. 

Nov.  25,  1912 

Intoxication 

11 

Oct.     9,  1912 

C.  of  C. 

On  Reg.  Dec.  17, 

1912 

22 

Jan.     2,  1912 

C.  of  C. 

Jan.     4,  1912 

Ref.  F.C. 

ADMISSIONS  TO  CITY  HOMES 


317 


No.  of 

Date 

By  Whom 

Date  of 

Cause  of 

Case 

Readmitted 

Readmitted 

Discharge 

Discharge 

26 

Jan.   13,  1912 

Hosp. 

Mar.  25,  1912 

Own  Req. 

Nov.  16,  1912 

C.  of  C. 

On  Reg.  Dec.  17, 

,  1912 

28 

Apr.  29,  1912 

C.  of  C. 

Aug.  28,  1912 

Own  Req. 

30 

Dec.  28, 1911 

C.  of  C. 

Dec.  29,  1911 

To  C.  of  C. 

" 

Jan.     3,  1912 

C.  of  C. 

Jan.    11,  1912 

F.C. 

" 

Mar.  23,  1912 

C.  of  C. 

May  21,  1912 

Ref.  F.C. 

" 

July  19,  1912 

C.  of  C. 

July  24,  1912 

Absconded 

" 

Aug.    7,1912 

C.  of  C. 

Aug.  15,  1912 

Ref.  F.C. 

32 

Jan.     2,  1912 

C.  of  C. 

Jan.     4,  1912 

F.C. 

33 

Feb.  21, 1912 

C.  of  C. 

On  Reg.  Aug.    8, 

1912 

37 

Jan.  22,  1912 

C.  of  C. 

On  Reg.  Dec.  17, 

1912 

40 

Deo.  30,  1911 

C.  of  C. 

Apr.     1,  1912 

Own  Req. 

" 

May  24,  1911 

C.  of  C. 

June    3,  1912 

Own  Req. 

'' 

June  15,  1912 

C.  of  C. 

June  20,  1912 

Own  Req. 

44 

July  29,  1912 

C.  of  C. 

On  Reg.  Aug.    8, 

1912 

46 

June  18,  1912 

C.  of  C. 

On  Reg.  Aug.    8, 

1912 

50 

Dec.    4,  1911 

Hosp. 

Dec.  21,  1911 

F.C. 

67 

Oct.  29,  1911 

C.  of  C. 

On  Reg.  Dec.  17, 

1912 

59 

Dec.  13,  1911 

Hosp. 

Dec.  21,  1911 

F.C. 

62 

Dec.  IS,  1911 

C.  of  C. 

Dec.  21,  1911 

F.C. 

" 

Feb.  21,  1912 

C.  of  C. 

Feb.  27, 1912 

Own  Req. 

" 

Apr.     9,  1912 

C.  of  C. 

Apr.  15,  1912 

Own  Req. 

67 

July  25,  1912 

C.  of  C. 

July  25,  1912 

F.C. 

" 

Nov.  18,  1912 

C.  of  C. 

On  Reg.  Dec.  17, 

1912 

71 

Aug.  20,  1912 

Hosp. 

On  Reg.  Nov.  25, 

1912 

73 

Apr.  12,  1912 

C.  of  C. 

Apr.  22,  1912 

Own  Req. 

" 

June  25,  1912 

C.  of  C. 

July  15,  1912 

Own  Req. 

" 

Aug.  27,  1912 

C.  of  C. 

Aug.  31,  1912 

Own  Req. 

" 

Sept.  18,  1912 

C.  of  C. 

Sept.  30,  1912 

Own  Req. 

" 

Nov.  11,  1912 

C.  of  C. 

Nov.  21,  1912 

Ref.  F.C. 

79 

Jan.   17,1912 

C.  of  C. 

Mar.  25,  1912 

Own  Req. 

88 

Sept.  23,  1912 

C.  of  C. 

Sept.  24,  1912 

F.C. 

97 

May  30,  1912 

C.  of  C. 

June    3,  1912 

Own  Req. 

98 

Dec.  20,  1911 

Hosp. 

Dec.  21,  1911 

Ref.  F.C. 

108 

Aug.    8,  1912 

C.  of  C. 

On  Reg.  Aug.  15, 

1912 

115 

Aug.  16, 1912 

C.  of  C. 

Aug.  19,  1912 

Ref.  F.C. 

121 

Aug.  11,  1912 

Hosp. 

Oct.     3,  1912 

Ward  33, 

Hosp. 
Own  Req. 

125 

Oct.  28,  1911 

C.  of  C. 

Mar.  27,  1912 

129 

Aug.    6,  1912 

C.  of  C. 

On  Reg.  Nov.  25, 

1912 

135 

July     3,  1912 

C.  of  C. 

July  13,  1912 

Own  Req. 

" 

July  22,  1912 

C.  of  C. 

July  25,  1912 

Ref.  F.C. 

150 

Aug.  13,  1912 

C.  of  C. 

Aug.  14,  1912 

Ref.  F.C. 

154 

Aug.  13,  1912 

C.  of  C. 

On  Reg.  Aug.  15, 

1912 

160 

Nov.  11,  1911 

C.  of  C. 

Nov.  14,  1911 

Absconded 

" 

Jan.     7,  1912 

C.  of  C. 

On  Reg.  Deo.  17, 

1912 

161 

July     6,1912 

C.  of  C. 

On  Reg.  Aug.  15, 

1912 

162 

Mar.  19,  1912 

C.  of  C. 

Apr.  11,  1912 

Own  Req. 

" 

Apr.  18,  1912 

C.  of  C. 

May  10,  1912 

Own  Req. 

" 

July  16,  1912 

C.  of  C. 

July  17,  1912 

Ward  43, 

Hosp. 
F.C. 

" 

Sept.  26,  1912 

C.  of  C. 

Oct.   31,1912 

163 

Feb.     9,  1912 

C.  of  C. 

Mar.  18,  1912 

Own  Req. 

<( 

May  22,  1912 

C.  of  C. 

May  25,  1912 

Own  Req. 

" 

July  18,  1912 

C.  of  C. 

July  24,  1912 

Ref.  F.C. 

<t 

Aug.  27,  1912 

C.  of  C. 

Aug.  30,  1912 

Own  Req. 

" 

Sept.    8,  1912 

C.  of  C. 

Sept.  23,  1912 

Own  Req. 

" 

Sept.  30,  1912 

C.  of  C. 

Oct.   15,  1912 

Absconded 

" 

Nov.    6,  1912 

C.  of  C. 

Nov.  14,  1912 

Absconded 

" 

Dec.    5,  1912 

C.  of  C. 

Dec.  16,  1912 

Absconded 

168 

Dec.  23,  1911 

C.  of  C. 

Dec.  26,  1911 

Died 

170 

Dec.    2,  1912 

C.  of  C. 

On  Reg.  Dec.  17, 

1912 

3i8 


HOSPITAL   COMMITTEE 


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ADMISSIONS   TO   CITY  HOMES 


319 


TABLE  XXXV. 

New  York  City  Farm  Colony. 

This  Table  is  a  Copy  of  the  Farm  Colony  Records,  with  Footings  and  Percentages  Added 
by  the  Investigators. 

Causes  for  Admission  July  1,  1911,  to  May  31,  1912. 

I 
Sus- 
Out  of    Sickness  Old  Age  Epileptic  Insane  Crippled  pected        Total 
Work  Insane 

M.    F.     M.    F.     M.    P.     M.    F.     M.    P.     M.    P.     M.    P. 


July. 


45     1       15     6      24    3 


August 24 

September. ...  23 

October 86 

November ....  57 

December.  ...  83 

January 72 

February 32 

March 5 

April 24 

May 32 


5     2 
7   .. 


30 
28 
26 
20 
18 
3 


13 

4 

15 

28 

15 

2 

18 

1 

13 

21 


25     167  22     154  20 


2  3 

44 

145 
(1  M.  Ch'd) 

IS 

3 

3 

72 

2  2 

4 

1 

1 

48 

2  5 

22 

4 

1 

176 

1  1 

29 

1 

154 

5  1 

9 

148 

..  1 

14 

1 

1 

115 

..  1 

14 

1 

87 

3  1 

19 

3  1 

10 

66 

6  2 

21 

1 

1 

98 

24  18 

185 

8 

7 

4 

1,128 

45.0%     16.8%     15.4%      1.0%      3.7%     17.1%      1.0%  100.0% 

■ 

Note:     There  are  two  errors  in  this  tabulation,  there  being  one  dependent  too  few 

in  August  and  three  too  many  in  December,  making  an  excess  of  two  dependents  in  the 

eleven  months.     The  latter  error  was  corrected  on  the  Colony  census  records  after  attention 

was  called  to  it. 

TABLE  XXXVI. 

New  York  City  Farm  Colony. 

Authorizations  for  Admission  Found  on  File  at  the  Colony  for  the  g8  Admissions  in  May,  igis. 


Admissions  Having  Authorizations  at  the  Colony  from  the  Bureaus 

of  Dependent  Adults 

Permits  from  the  Bureau  of  Dependent  Adults,  Manhattan 56 

Permits  bearing  the  name  of  a  clerk  in  the  Bureau  of  Dependent 

Adults,  Brooklyn 15 

Permits  from  the  Bureau  of  Dependent  Adults,  Richmond 11 

82 
Admissions  Not  Having  Authorizations  at  the  Home  from  the 

Bureaus  of  Dependent  Adults 

Commitments  by  magistrates  for  observation  as   to    sanity  with 

commitment  papers  on  file  at  the  Colony 7 

Commitment  by  magistrates  for  observation  with  no  commitment 

papers  found  on  file 1 

Admissions  from  the  House  of  Divine  Providence,  S.  I.,  for  whom 

no  permits  were  found  on  file 1 

Admissions  of  former  inmates  of  the  Colony  for  whom  no  permits 

were  found  on  file 2 

Admissions  of  former  inmates  of  municipal  institutions  for  whom 

no  permits  were  found  on  file 2 

Admissions  entered  on  books  to  correct  previous  alleged  erroneous 

entries  of  discharge 3 


82 


16 


16 


320 


HOSPITAL   COMMITTEE 


TABLE  XXXVII. 

New  York  City  Farm  Colony. 

Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  Qi  Dependents  Entered 

tipon  the  Records  of  Admission  to  the  Colony  in  May,  igis. 

Residences  of  dependents  just  prior  to  admission 13,  or  14.3% 

Residences  of  dependents  at  some  time  before  admission S,   "  8.8% 

Addresses  where  dependents  were  not  known 35,  "  38.4% 

Addresses  of  lodging  houses 12,   "  13.2% 

Addresses  that  were  not  residential 2,   "  2.2% 

Addresses  that  were  not  sufBciently  explicit  for  investigation 12,   "  13.2% 

Addresses  that  were  outside  of  the  City 2,   "  2.2% 

Dependents  admitted  without  residential  addresses 7,   "  7.7% 

Total 91,  or  100.0% 

TABLE  XXXVIII. 
New  York  City  Farm  Colony. 
Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  QO  Relatives  and  Friends 
of  Dependents  Entered  upon  the  Records  of  Admission  in  May,  IQ12. 

Residences  of  relatives  or  friends  just  prior  to  the  admission 24,  or  26.7% 

Residences  of  relatives  or  friends  at  some  time  before  the  admission 5,   "     5.6% 

Addresses  where  relatives  or  friends  were  not  known 32,   "  35.5% 

Addresses  of  lodging  houses 3,   "     ^  •  ^^ 

Addresses  that  were  not  residential 9,   "  10 . 0% 

Addresses  that  were  not  suiSciently  explicit  for  investigation S,   "     8.9% 

Addresses  that  were  outside  of  the  City 9,   "  10.0% 

Total 90,  or  100.0% 

Note:     The  records  for  19  admissions  during  this  month  had  no  names  and  addresses 
of  relatives  or  friends  entered  upon  them. 

TABLE  XXXIX. 
New  York  City  Farm  Colony. 
Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  lOQ  Dependents  Entered 
upon  the  Records  of  Admission  to  the  Colony  in  December,  IQII. 

Residences  of  dependents  just  prior  to  admission 9,  or    8.2% 

Residences  of  dependents  at  some  time  before  admission 1,  "       .9% 

Addresses  where  dependents  were  not  known 8,   "     7.3% 

Addresses  of  lodging  houses 13,   "  12 . 0% 

Addresses  that  were  not  residential 5,   "     4.6% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 7,  *     6.4% 

Addresses  that  were  outside  of  the  City 1,   "        .9% 

Dependents  admitted  without  residential  addresses 65,   "  59.7% 

Total 109,  or  100.0% 

TABLE  XL. 
New  York  City  Farm  Colony. 
Findings,  After  Investigation,  Regarding  the  Residence  Addresses  of  67  Relatives  and  Friends 
of  Dependents  Entered  upon  the  Records  of  Admission  in  December,  jgii. 

Residences  of  relatives  or  friends  just  prior  to  the  admission. 22,  or  32.8% 

Residences  of  relatives  or  friends  at  some  time  before  the  admission 1,  "     1.4% 

Addresses  where  relatives  or  friends  were  not  known 15,   "  22.4% 

Addresses  of  lodging  houses 3,   "     4.5% 

Addresses  that  were  not  residential 6,   "     9.0% 

Addresses  that  were  not  sufficiently  explicit  for  investigation 5,   "     7.5% 

Addresses  that  were  outside  of  the  City 15,   "  22.4% 

Total 67,  or  100.0%, 

Note:    The  records  for  34  admissions  during  this  month  had  no  names  and  addresses 
of  relatives  or  friends  entered  upon  them. 


ADMISSIONS   TO   CITY  HOMES  32I 

TABLE  XLI. 

New  York  City  Farm  Colony. 

Findings,  After  Investigation,  Regarding  the  Character  of  the  g8  Dependents  Admitted 
in  May,  igi2. 

Admissions  That  Could  Not  be  Classified  as  to  Character  for 
THE  Following  Reasons:  51 

The  addresses  found  at  the  Colony  were  insufficient  in 13  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 31      " 

The  addresses  given  were  too  old  in 3      " 

Sufficiently  complete  histories  could  not  be  secured  in 4      " 

51  Cases 
Admissions  Classified  as  to  Character:  47 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon 

the  City's  support. 17,  or  36.2% 

Dependents  who  were  aliens 16,  "  34 . 0% 

Dependents  alleged  to  have  been  insane 7,   "  15.0% 

Dependents  who  had  legally  responsible  relatives  able  to  pay 

for  their  maintenance 1,   "     2.1% 

Dependents  who  were  personally  able  to  pay  for  their  main- 
tenance      1,"     2.1% 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy.  ....     1,  "     2.1% 
Dependents  who  had  relatives  willing  to  support  them  in  their 

own  homes 1,  "     2.1% 

Dependents  who  had  relatives  not  legally  responsible  but  able 

to  pay  for  their  maintenance 2,   "     4.3% 

Dependents  who  were  able  to  work  to  earn  their  own  support. .     1,   "     2.1% 

47,  or  100.0% 

Total 98 


TABLE  XLII. 

New  York  City  Farm  Colony. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Dependents  Admitted  in  May,  IQIS, 
and  Found,  After  Investigation,  to  Fall  into  Certain  Groups. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     I S808.48 

Group    II 123.49 

Group  III 213.15 

Total §1,145.12 


322  HOSPITAL    COMMITTEE 

TABLE  XLIII. 

New  York  City  Farm  Colony. 

Estimate  of  Expense  to  the. City  of  the  Maintenance  of  Dependents  Admitted  in  May,  igiz: 

for  Those  Found,  After  Investigation,  to  Fall  into  the  Groups  Shown;  and  for  Those 

Who  Could  Not  be  Classified,  but  Who  Would  Have  Fallen  into  These  Groups 

on  the  Basis  of  the  Proportions  in  Each  Group  of  Those  Classified. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     1 81,755.79 

Group    II 165.82 

Group  III 447.62 

Total $2,369.23 


TABLE  XLIV. 

New  York  City  Farm  Colony. 

Findings,  After  Investigation,  Regarding  the   Character  of  po  Dependents  Admitted  in 
December,  igii. 

Admissions  That  Could  Not  be  Classified  as  to  Character  for  the 
Following  Reasons:  55 

The  addresses  at  the  Colony  were  insufficient  in 23  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 27      " 

Sufficiently  complete  histories  could  not  be  secured  in 5      " 

55  Cases 
Admissions  Classified  as  to  Character:  35 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon 
the  City's  support 10,  or  28.6% 

Dependents  who  were  aliens 17,   "  48.6% 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for 

their  maintenance 4,   "  11.5% 

Dependents  who  were  personally  able  to  pay  for  their  main- 
tenance      2,  "     5.7% 

Dependents  who  had  relatives  willing  to  support  them  in  their 
own  homes 1,  "     2.8% 

Dependents  who  were  able  to  work  to  earn  their  own  support.     1,  "    2.8% 

35,  or  100.0% 
Total 90 


ADMISSIONS  TO   CITY  HOMES  323 

TABLE  XLV. 

New  York  City  Farm  Colony. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Dependents  Admitted  in  December,  iQil, 
and  Found,  After  Investigation,  to  Fall  into  Certain  Groups. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 
Dependents  who  were  personally  able  to  pay  for  their  maintenance. 
Dependents  who  were  aliens. 
Dependents  who  were  non-residents  of  the  City. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     I $2,590.62 

Group  III 74.65 


Total $2,674.27 


TABLE  XLVI. 

New  York  City  Farm  Colony. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Dependents  Admitted  in  December,  iQii: 

for  Those  Found,  After  Investigation,  to  Fall  into  the  Groups  Shown;  and  for  Those 

Who  Could  Not  be  Classified,  but  Who  Would  have  Fallen  into  These  Groups  on 

the  Basis  of  the  Proportions  in  Each  Group  of  Those  Classified. 

— ■ 
Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 
Dependents  who  were  personally  able  to  pay  for  their  maintenance. 
Dependents  who  were  aliens. 
Dependents  who  were  non-residents  of  the  City. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Estimated  Expense: 

Group     I $10,956.50 

Group  III 314.62 

Total $11,271.12 


324  HOSPITAL   COMMITTEE 

TABLE  XLVII. 

Admissions  to  Almshouses  of  New  York. 

Authorizations  for  Admission  Found  on  File  at  the  Almshouses  for  the  S02  Admissions 

in  May,  igi2. 

Admissions  Having  Authorizations  at  the  Almshouses  from  the 

Bureaus  of  Dependent  Adults 507 

Permits  bearing  tlie  name  of  a  Superintendent  of  a  Bureau  of  Depen- 
dent Adults 208 

Permits  bearing  the  name  of  the  Examining  Physician 102 

Permits  bearing  the  name  of  a  clerk  in  the  Bureau  of  Dependent 

Adults,  Brooklyn 197 

507 
Admissions  Not  Having  Authorizations  at  the  Almshouses  from 

THE  Bureaus  of  Dependent  Adults 85 

Transfer  sHps  bearing  the  name  of  the  Superintendent  of  Kings 

County  Hospital 56 

Admission  slips  bearing  the  names  of  doctors  at  municipal  hospitals .  8 

Commitments  by  magistrates  with  papers  on  file 7 

Commitments  by  magistrates  with  no  papers  on  file 1 

Admission  slips  to  City  Home,  Manhattan,  bearing  the  name  of 

the  Superintendent  of  Farm  Colony 1 

Admissions  entered  for  which  there  were  no  permits  or  slips  on  file. .     12        

Total ~85  592 


TABLE  XLVIII. 

Admissions  to  Almshouses  of  New  York. 

Findings,  After  Investigation,  Regarding  the  Character  of  868  Dependents  Admitted 

During  Certain  Periods 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division,  December, 

1911  (Males) 186 

New  York  City  Home  for  the  Aged  and  Infirm,  Manhattan  Division,  May,  1912 

(Males) 253 

New  York  City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division,  May,  1912 241 

New  York  City  Farm  Colony,  December,  1911 90 

New  York  City  Farm  Colony,  May,  1912 98 

Total 868 

Admissions  That  Could  Not  be  Classified  as  to  Character  for  the  Fol- 
lowing Reasons: 

The  addresses  found  at  the  almshouses  were  insufficient  in 107  Cases 

The  dependents  were  unknown  at  the  addresses  given  in 219      " 

The  addresses  given  were  too  old  in 19      " 

Sufficiently  complete  histories  could  not  be  secured  in 61      " 

406  Cases 
Admissions  Classified *as  to  Character: 

Dependents  who  seemed  to  have  had  a  legitimate  claim  upon  the 

City's  support 230,  or  49.8% 

Dependents  who  were  aliens 125,  "  27.0% 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their 

maintenance 34,   "     7.4% 

Dependents  who  did  not  have  a  legal  settlement  in  New  York  City.     17,  "     3.7% 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in 

their  own  homes 14,   "     3.0% 

Dependents  who  were  able  to  work  to  earn  their  own  support 11,    "     2.4% 

Dependents  who  were  personally  able  to  pay  for  their  maintenance .       9,   "     2.0% 
Dependents  who  had  served  in  the  U.  S.  Army  or  Navy,  or  who 
were  widows  of  men  who  had  served  in  the  U.  S.  Army  or  Navy . .       7,  "     1.5% 

Dependents  who  were  alleged  to  be  insane 7,   "     1.5% 

Dependents  who  had  relatives  not  legally  responsible  but  able  to 

pay  for  their  maintenance 8,   "     1.7% 

Total 462,  or  100.0% 


ADMISSIONS   TO   CITY  HOMES  325 

TABLE  XLIX. 

Admissions  to  Almshouses  of  New  York. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Dependents  Admitted  in  Two  Months 
and  Found,  After  Investigation,  to  Fall  into  Certain  Groups. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.  Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Institution  Admitted  Group  I         Group  II        Group  III  Total 

City  Home,  Manhattan.  Dec.  1911  $5,363.11  $235.59  $102.48  $5,701.28 

"         "                  "          May,  1912  3,793.72  1,579.94  485..52  5,859.18 

Brooklyn..   May,  1912  766.00  42.77  706.47  1,515.24 

Farm  Colony Dec,  1911  2,599.62           74.65  2,674.27 

*           "      May,  1912  808.48  123.49  213.15  1,145.12 

Total $13,330.93        $1,981.89        $1,582.27     $16,895.09 


TABLE  L. 

Admissions  to  Almshouses  of  New  York. 

Estimate  of  Expense  to  the  City  of  the  Maintenance  of  Dependents  Admitted  in  Two  Months: 

for  Those  Found,  After  Investigation,  to  Fall  into  the  Groups  Shown;  and  for  Those 

Who  Could  Not  be  Classified,  but  Who  Would  Have  Fallen  into  These  Groups 

on  the  Basis  of  the  Proportions  in  Each  Group  of  Those   Classified. 

Group  I. 

Dependents  who  had  legally  responsible  relatives  able  to  pay  for  their  maintenance. 

Dependents  who  were  personally  able  to  pay  for  their  maintenance. 

Dependents  who  were  aliens. 

Dependents  who  were  non-residents  of  the  City. 

Group  II. 

Dependents  who  had  served  in  the  U.  S.  Army  or  Navy. 

Dependents  who  were  wives  or  children  of  men  who  had  served  in  the  U.  S.   Army  or 
Navy. 

Group  III. 

Dependents  who  had  relatives  not  legally  responsible  for  their  support  but  able  to  pay 

for  their  maintenance. 
Dependents  who  had  relatives  or  friends  willing  to  support  them  in  their  own  homes. 
Dependents  who  were  able  to  work  to  earn  their  own  support. 

Institution              Admitted  Group  I  Group  II  Group  III  Total 

City  Home,  Manhattan.  Dec,  1911  $10,726.22  $471.38  $204.96  $11,402  56 

"         "                  "          May,  1912  5,774.30  2,404.78  739.00  8,918.08 

"         "        Brooklyn..   May,  1912  1,619.44  90.42  1,493..59  3,203.45 

Farm  Colony Dec,  1911  10,956.50         314.62  11,271.12 

"           "      May,  1912  1,755.79  165.82  447.62  2,369.23 

Total $30,832.25        $3,132.40        $3,199.79      837,164.44 


APPENDIX 

TO 

ADMISSIONS  TO  CITY  HOMES  (ALMSHOUSES) 

Extracts  from  Information  Gathered  Regarding  Some  Dependents 
Admitted  to  the  City  Homes  in  December,  1911,  and  May,  1912 

The  first  paragraph  in  each  of  the  following  brief  digests  states  the 
nationality,  age,  and  occupation  of  the  dependent. 

The  second  paragraph  gives  a  summary  of  the  findings  of  the  investiga- 
tors of  the  Committee,  which  determined  the  classification  of  the  dependent. 

Case.  i.    A  native  of  Russia.     Age  27.     Occupation,  laborer. 

An  alien  who  had  been  in  the  country  only  4  months.  The  Home  records  also 
showed  that  he  was  in  good  physical  condition  and  able  to  work.  At  the  time  of  in- 
vestigation it  was  found  that  the  dependent  had  been  sent  back  to  Russia  by  the 
State  Board  of  Charities. 

Case  2.     A  native  of  Ireland.     Age  yd.     Occupation,  upholsterer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  He 
was  without  relatives  in  the  United  States. 

Case  3.    A  native  of  Germany.     Age  70.     Occupation,  gardener. 

At  the  time  of  investigation  it  was  found  that  this  dependent  was  an  unnatur- 
alized alien,  and  had  come  from  New  Jersey  only  8  days  before  admission. 

Case  4.    A  native  of  the  United  States.     Age  20.     Occupation,  printer. 

This  dependent  was  a  non-resident.  The  Home  records  also  showed  him  to  be  in 
good  physical  condition  and  able  to  work.  At  the  time  of  investigation  the  State 
Board  of  Charities  was  found  to  have  sent  the  dependent  to  a  relative  in  Ohio. 

Case  5.     A  native  of  Switzerland.     Age  56.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien.  At 
the  time  of  investigation  the  dependent  was  unknown  at  the  address  given. 

Case  6.    A  native  of  Roumania.     Age  70.     Occupation,  cutter. 

The  dependent's  daughter  said  that  her  father  lived  with  her  but  that  when  he  be- 
came sick  her  husband  would  not  let  her  continue  the  care  of  him.  The  dependent 
then  went  to  live  with  his  son,  who  kept  him  about  2  weeks  and  then  turned  him 
out.  The  daughter  lived  in  a  very  good  apartment.  She  said  that  her  brother  was 
a  travelling  man,  who  earned  a  good  salary  but  would  do  nothing  for  his  father. 
The  dependent  was  said  to  be  sleeping  in  a  barber  shop.  The  Home  records  showed 
that  this  dependent  had  been  in  the  United  States  only  s  years  and  was  not  a  citizen. 
The  case  was  referred  to  the  State  Board  of  Charities,  but  was  discharged  by  them 
without  any  action  having  been  taken. 

Case  7.     A  native  of  Ireland.    Age  35.    Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  had  been  in  the  United  States 
only  II  days,  and  that  he  was  in  good  physical  condition  and  able  to  work.  Investi- 
gation discovered  that  the  State  Board  of  Charities  had  sent  him  back  to  Ireland. 

Case  8.    A  native  of  Scotland.    Age  62.    Occupation,  waiter. 

The  investigator  was  unable  to  locate  the  inmate  at  the  address  given.  The 
Home  records  showed  that  he  was  an  alien,  with  7  admissions  to  the  institution. 

Case  9.    A  native  of  Scotland.     Age  62.     Occupation,  shoemaker. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
327 


328  HOSPITAL   COMMITTEE 

Case  io.    A  native  of  the  United   States.     Age  53.     Occupation,  housekeeper. 

At  the  time  of  investigation  it  was  found  that  this  dependent  had  children  who 
were  able  and  willing  to  pay  for  her  maintenance. 

Case  ii.    A  native  of  Germany.     Age  63.     Occupation,  druggist. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  There 
was  no  such  number  on  the  street  as  was  given  for  the  address  of  the  dependent's 
friend  on  the  Home  records. 

Case  12.    A  native  of  Germany.     Age  63.     Occupation,  druggist. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
Case  13.    A  native  of  the  United  States.    Age  52.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  physically  able  to  work  but 
that  he  was  admitted  because  he  was  out  of  employment.  He  has  a  stepmother  well 
able  to  care  for  him. 

Case  14.    A  native  of  Austria.    Age  40. 

This  dependent  had  been  in  this  country  about  s  years.  His  landlady  said  he  had 
left  the  Home  to  go  to  work  and  was  now  out  peddling.  She  also  stated  that  he  had 
just  taken  out  his  first  papers  and  was  not  yet  a  citizen. 

Case  15.    A  native  of  France.     Age  66.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien,  and 
had  been  admitted  21  times  to  this  Home  alone. 

Case  16.     A  native  of  Ireland.     Age  65.     Occupation,  musician. 

The  Home  records  showed  that  the  dependent  was  an  unnaturalized  alien,  and 
that  he  was  in  good  physical  condition. 

Case  17.    A  native  of  Ireland.    Age  58.    Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  They 
also  showed  that  he  was  in  good  physical  condition  and  able  to  work  but  without 
friends  in  the  United  States.  The  investigator  found  that  the  dependent  was  un- 
known at  the  address  he  gave. 

Case  18.    A  native  of  Ireland.     Age  80.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien,  and 
that  he  became  insane  after  this  admission. 

Case  19.    A  native  of  Germany.    Age  62.    Occupation,  painter. 

A  friend  said  that  this  dependent  was  able  and  willing  to  work  but  that  he  could 
not  find  employment.  She  was  willing  to  take  care  of  him,  but  rather  than  give  her 
the  expense  the  dependent  went  to  the  Home. 

Case  20.    A  native  of  the  United  States.     Age  53.     Occupation,  canvasser. 

The  Home  records  showed  that  this  dependent  had  been  in  the  state  only  7 
months.  At  the  time  of  investigation  he  was  in  Ohio,  where  he  was  being  cared  for 
by  his  brother. 

Case  21.    A  native  of  Germany.    Age  yy.     Occupation,  weaver. 

This  dependent's  daughter  said  that  he  had  a  son,  a  school  janitor,  earning  a  very 
good  salary.  This  son  was  found  willing  to  pay  $8  per  month  for  his  father's  mainte- 
nance.   The  dependent  had  another  son,  a  property  owner  in  New  Jersey. 

Case  22.    A  native  of  the  United  States.     Age  48.    Occupation,  upholsterer. 

This  dependent  was  able  to  work,  but  was  out  of  employment  at  the  time  of 
admission.  When  investigated  it  was  found  that  this  dependent's  children  were  able 
to  support  their  father,  but  were  unwilling,  as  he  was  quite  able  to  support  himself. 

Case  23.    A  native  of  Germany.     Age  61.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 

Case  24.    A  native  of  Roumania.     Age  69.     Occupation,  druggist. 

This  dependent  owned  and  operated  a  drug  store.  A  friend  clairaiiig  to_  have 
known  him  for  11  years  said  that  the  dependent's  wife  and  family  live  in  Vienna, 


ADMISSIONS   TO   CITY   HOMES 


329 


with  the  exception  of  i  son,  who  lives  somewhere  in  New  England  and  earns  about 
$35  per  week.    The  dependent  had  called  in  a  private  physician  for  medical  attention. 

Case  25.    A  native  of  Germany.     Age  60.     Occupation,   laborer. 

The  Home  records  showed  tliat  this  dependent  was  an  unnaturalized  alien.  No 
address  was  given  for  himself  or  friends. 

Case  26.    A  native  of  France.    Age  66.     Occupation,  hostler. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien.  The 
investigators  found  that  both  the  dependent  and  friends  were  unknown  at  the  address 
given. 

Case  27.    A  native  of  Ireland.    Age  49.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien.  The 
dependent  was  unknown  at  the  address  given. 

Case  28.     A  native  of  Ireland.    Age  53.    Occupation,  plasterer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien,  and 
also  a  cripple. 

Case  29.    A  native  of  Russia.    Age  30.    Occupation,  furrier. 

This  case  was  referred  to  the  State  Board  of  Charities,  and  the  dependent  was 
returned  to  Russia  by  the  Board.  The  entry  on  his  history  at  the  Home  was  that 
he  had  been  in  the  United  States  only  8  months. 

Case  30.     A  native  of  Germany.    Age  63.     Occupation,  tailor. 

When  investigated  it  was  learned  from  a  relative  that  this  dependent  had  a  sister 
who  was  in  good  circumstances,  but  did  nothing  for  her  brother. 

Case  31.    A  native  of  Germany.     Age  63.     Occupation,  druggist. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
Case  32.    A  native  of  Germany.     Age  67.     Occupation,  clothes  cleaner. 

A  widower.  The  Home  records  showed  that  he  was  an  unnaturalized  alien.  The 
investigator  was  unable  to  locate  him  at  the  address  given. 

Case  33.    A  native  of  Ireland.     Age  62.     Occupation,  mason. 

The  Home  records  showed  that  the  dependent  was  able  to  work  when  he  entered 
the  Home.  The  dependent  died.  He  was  insured  for  $200,  but  had  no  dependent 
relatives. 

Case  34.    A  native  of  Norway.     Age  64  or  over.     Occupation,  longshoreman. 

This  dependent  said  he  had  3  sons — 2  in  business  here,  and  i  in  Norway — and 
had  received  money  from  them.     He  thought  they  were  able  to  support  him. 

Case  35.    A  native  of  Italy.     Age  22.     Occupation,  laborer. 

An  alien,  who  had  lived  i  year  in  the  United  States  but  had  not  taken  out 
his  papers,  according  to  the  Home  records.  The  friends  were  not  known  at  the 
addresses  given. 

Case  36.     A  native  of  Germany.     Age  38.     Occupation,  cook. 

According  to  the  Colony  records  this  dependent  was  an  alien  who  had  been  in 
the  United  States  only  2>^  years,  and  in  New  York  State  only  i  week.  The  records 
showed  that  he  was  admitted  because  he  was  out  of  employment  at  the  time,  and  was 
placed  on  the  payroll  of  the  Colony. 

Case  2>7-    A  native  of  Ireland.     Age  21.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  alien,  only  6  weeks  in  the 
United  States.  They  also  showed  that  he  was  in  good  condition  and  able  to  work. 
The  investigator  discovered  that  the  United  States  Government  had  returned  him  to 
Ireland. 

Case  38.    A  native  of  the  United  States.     Age  73.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  a  veteran,  and  was  not  mar- 
ried. 

Case  39.     A  native  of  Newfoundland.     Age  65.     Occupation,  cook. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien.  He 
was  also  shown  to  be  able  to  work  but  that  he  was  admitted  because  he  was  out  of 
employment. 


330  HOSPITAL   COMMITTEE 

Case  40.    A  native  of  Ireland.    Age  22.     Occupation,  laborer. 

According  to  the  Colony  records  this  dependent  was  an  alien,  having  been  in  the 
United  States  but  I  year. 

Case  41.     A  native  of  Ireland.     Age  69,     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  His 
landlady  thought  that  he  was  a  resident  of  New  Jersey,  where  he  was  found  to  have 
gone,  and  where  his  brother  lived. 

Case  42.     A  native  of  the  United  States.     Age  60.     Occupation,  laborer. 

A  daughter  of  this  dependent  said  that  her  father  had  been  drinking  and  went 
to  the  Home  without  the  knowledge  of  the  family.  The  dependent  had  2  sons  and 
I  daughter,  and,  when  investigated,  it  was  found  that  they  had  taken  him  out  of  the 
Home  and  were  supporting  him. 

Case  43.     A  native  of  Ireland.     Age  46.     Occupation,  mason. 

His  wife  said  that  she  and  her  husband  were  living  with  their  son,  who  was  a 
mason,  earning  $5.60  a  day.  The  family  occupied  a  nice  house.  Another  son  earned 
$4  a  day. 

Case  44.    A  native  of  Hungary.     Age  22.     Occupation,  painter. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  They 
also  showed  that  he  was  in  good  physical  condition  and  able  to  work.  Investigation 
developed  the  fact  that  he  had  been  deported  to   Hungary. 

Case  45.    A  native  of  England.     Age  50.     Occupation,  dishwasher. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  They 
also  showed  that  he  was  in  good  physical  condition  and  able  to  work.  At  the  time  of 
investigation  he  was  working  and  had  left  the  H6me  for  that  purpose. 

Case  46.    A  native  of  Germany.    Age  56  or  over.     Occupation,  tailor. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien.  At 
the  time  of  investigation  it  was  found  that  the  dependent  and  his  brother  and  sister 
were  all  unknown  at  the  addresses  given. 

Case  47.    A  native  of  Ireland.    Age  28.     Occupation,  laborer. 

The  Home  records  showed  that  he  had  had  only  7  months  residence  in  the 
country  and  S  months  in  the  City.  The  case  was  referred  to  the  State  Board  of  Chari- 
ties and  the  dependent  discharged,  as  ordered  by  them,  into  the  custody  of  his  sister. 

Case  48.    A  native  of  Ireland.    Age  54.     Occupation,  watchman. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  They 
also  showed  him  to  be  in  good  physical  condition  and  able  to  work. 

Case  49.    A  native  of  the  United  States.    Age  60.     Occupation,  gardener. 

The  investigator  was  unable  to  locate  the  dependent  at  the  address  given.  An 
acquaintance  was  seen  who  stated  that  the  dependent  was  then  employed  as  an  or- 
derly in  a  municipal  hospital.  The  patient  had  been  employed  by  him  on  several  occa- 
sions. He  had  relatives  living  in  Connecticut.  The  informant  would  not  say  that 
they  were  able  to  maintain  the  dependent,  but  the  dependent  was  able  to  work  and 
maintain  himself.  Information  was  received  from  another  source  that  the  dependent 
had  a  sister  living  in  Europe  who  made  monthly  remittances  to  him. 

Case  50.     A  native  of  the  United  States.     Age  36.     Occupation,  chauffeur. 

The  mother  stated  that  the  dependent  had  a  brother,  a  chauffeur,  who  owned  his 
own  business. 

Case  51.     A  native  of  Italy.     Age  70.     Occupation,  tailor. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  At 
the  time  of  investigation  it  was  discovered  that  a  relative,  after  some  difficulty,  had 
located  the  dependent  at  the  Home  and  had  removed  him  to  support  him  at  his  own 
home. 

Case  52.     A  native  of  Ireland.     Age  70.     Occupation,  plasterer. 

A  sister  said  that  the  dependent's  children  were  able  and  willing  to  care  for  their 
father  if  he  would  live  a  decent  life.     The  dependent  had  3  sons  and  4  daughters. 


ADMISSIONS   TO   CITY  HOMES  331 

Case  53.    A  native  of  the  United  States.    Age  54  or  over.     Occupation,  driver. 

The  dependent's  niece  stated  that  he  was  strong  and  heahhy,  and  well  able  to 
work.  He  had  lived  with  her  almost  all  his  life,  but  drank  periodically,  and  then  be- 
came objectionable.  If  he  would  behave  properly  she  would  be  willing  to 
take  him  back  and  give  him  a  home.  The  entries  at  the  Home  showed  the  dependent 
to  have  been  admitted  there  7  times. 

C.^SE  54.     A  native  of  Greece.    Age  15. 

This  case  was  referred  to  the  Federal  Government  by  the  State  Board  of  Chari- 
ties, but  no  action  was  taken  by  the  Government  for  3  months.  Then  the  dependent 
was  sent  to  Chicago,  III.,  at  his  own  expense. 

Case  55.    A  native  of  Ireland.     Age  55.     Occupation,  fireman. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  His 
wife  said  that  he  was  well  and  able  to  work,  and  that  he  went  to  the  Home  because 
she  would  not  allow  his  children  to  support  him.  He  was  found  working  and  giving 
$7  a  week  toward  the  support  of  the  family.    He  also  had  3  children  earning  wages. 

Case  56.     A  native  of  Italy.    Age  51.    Occupation,  storekeeper. 

A  widower.  The  Home  records  showed  that  the  dependent  was  an  unnaturahzed 
alien.  The  janitress  at  the  address  given  stated  that  the  dependent  had  returned  to 
Italy. 

Case  57.    A  native  of  Ireland.     Age  69.     Occupation,  gardener. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien.  When 
investigated  the  dependent's  relative   was  unknown  at  the  address  given. 

Case  58.     A  German.     Age  72.     Formerly  an  engraver  by  occupation. 

His  2  daughters  had  paid  his  board  at  a  boarding-house.  These  daughters  were 
employed  and  earned  good  wages,  and  they  had  been  very  prompt  in  paying  their 
fathers  board. 

Case  59.     A  native  of  the  United  States.     Age  28.     Occupation,  peddler. 

A  non-resident  who,  according  to  Home  records,  had  been  in  New  York  City 
only  6  months.  Investigation  showed  that  the  State  Board  of  Charities  had  sent  him 
to  New  Jersey  at  his  own  expense. 

Case  60.     A  native  of  the  United   States.     Age  45.     Occupation,  cook. 

According  to  the  Colony  records  this  dependent  was  in  good  condition  and  able 
to  work  but  had  been  out  of  employment  before  the  time  of  admission.  At  the  time 
of  investigation  the  dependent  had  a  position  and  looked  well. 

Case  61.    A  native  of  Ireland.     Age  52  or  over.     Occupation,  stableman. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien.  The 
records  also  showed  him  to  be  in  good  physical  condition,  able  to  work,  but  out  of 
employment.     He  had  no  relatives  in  this   country. 

Case  62.     A  native  of  Germany.     Age  63.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
The  investigator  found  no  such  place  as  the  address  given. 

Case  63.     A  native  of  Austria.     Age  66.     Occupation,  weaver. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
The  records  also  showed  him  to  be  in  good  condition  and  able  to  work,  but  that  he 
was  out  of  employment  at  the  time  of  admission.  The  dependent  was  unknown  at 
the  address  given,  and  without  relatives  or  friends  in  the  United  States. 

Case  64.    A  native  of  Ireland.     Age  55.     Occupation,  laborer. 

According  to  the  Colony  records  this  dependent  was  able  to  work,  but  he  was 
out  of  employment  at  the  time  of  admission.  When  investigated  it  was  found  that 
the  dependent  might  have  a  home  with  his  wife  and  children  if  he  wished  it. 

Case  65.    A  native  of  the  United  States.     Age  50.     Occupation,  proofreader. 

A  sister-in-law  said  that  the  dependent's  3  children  were  in  good  circumstances 
but  had  refused  to  support  him. 


332  HOSPITAL   COMMITTEE 

Case  66.     A  native  of  Ireland.     Age  68.     Occupation,  laborer. 

The   Colony   records    showed    that   this    dependent    was   an    unnaturalized    alien. 

Case  67.    A  native  of  the  United  States.     Age  72.    Occupation,  furrier. 

This  dependent  was  a  non-resident  of  New  York  City.  The  Home  records 
showed  him  to  be  in  good  physical  condition.  Investigation  showed  that  he  came 
to  New  York  expecting  to  find  relatives,  and,  not  finding  them,  went  to  the  Home. 
He  was  sent  to  Illinois  by  the  State  Board  of  Charities. 

Case  68.    A  native  of  Germany.    Age  70. 

A  citizen  of  the  United  States.  He  was  an  inmate  of  the  Home  3  days  pre- 
ceding his  death.  The  investigator  talked  with  his  son,  who  had  paid  $1.40  per  day 
for  3  days,  a  total  of  $4.50,  to  the  cashier  at  the  Bureau  of  Dependent  Adults  for 
his  father's  maintenance  in  the  Home. 

Case  69.    A  native  of  Ireland.    Age  55  or  over.     Occupation,   laborer. 

A  friend  said  that  this  dependent  had  3  sons,  who  were  well  able  to  support 
their  father,  and  a  well-to-do  sister  in  Ireland.  At  the  time  of  the  investigation  the 
dependent  was  found  to  have  secured  a  position. 

Case  70.    A  native  of  Italy.     Age  67.     Occupation,  confectioner. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  found  living  at  home,  with  a  daughter  and  2  unmarried  sons,  both  of  whom 
earned  wages.     The  dependent  left  the  Home  because  he  was  tired  of  it. 

Case  71.    A  native  of  Ireland.     Age  29.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
The  records  also  showed  that  he  was  in  good  physical  condition  but  that  he  was 
admitted  because  he  was  out  of  employment  at  the  time.  He  had  no  relatives  in 
United  States. 

Case  72.    A  native  of  Ireland.    Age  54  or  over.    Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
The  dependent  and  his  friend  were  both  unknown  at  the  address  given. 

Case  73.    A  native  of  Germany.     Age  67.     Occupation,  bookbinder. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  without  relatives  or  friends  in  the  United  States. 

Case  74.    A  native  of  Germany.     Age  68.     Occupation,  janitor. 

One  daughter  said  that  her  father  was  sent  to  a  municipal  hospital,  and  was  trans- 
ferred to  the  Home  without  her  consent  or  knowledge.  She  would  have  given  him 
a  home.  A  wife  of  i  of  the  2  sons  said  that  her  husband  had  given  the  dependent  a 
home  for  years,  and  offered  to  take  him  out  of  the  Home. 

Case  75.    A  native  of  Scotland.    Age  60. 

A  childless  widow.  Her  residence  could  not  be  located  at  the  address  given,  it 
being  that  of  a  vacant  lot.  However,  a  cousin,  an  elderly  woman,  apparently  in  pros- 
perous circumstances,  stated  that  the  inmate  was  the  daughter  of  a  very  wealthy 
man,  one  of  the  richest  in  Scotland.  Her  cousin  and  her  daughters  united  in  saying 
that  they  were  anxious  to  give  the  dependent  a  home,  and  requested  the  investigator 
to  find  out  where  she  was,  so  that  they  could  bring  her  to  live  with  them. 

Case  76.    A  native  of  Germany.  Age  sg.     Occupation,  furrier. 

The    Colony   records    showed  that   this    dependent   was   an    unnaturalized   alien. 

When  investigated  it  was   found  that  the  dependent  was   unknown  at  the  address 
given. 

Case  yy.    A  native  of  Germany.     Age  72.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien  and 
that  he  was  without  relatives  or  friends  in  the  United  States. 

Case  78.    A  native  of  Germany.     Age  46.     Occupation,  tailor. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  had  a  wife  and  2  daughters  living  in  a  very  comfortable  apartment  house,  and 
the  janitress  said  she  thought  both  the  wife  and  i  of  the  2  daughters  were  working. 


ADMISSIONS   TO   CITY  HOMES  333 

Case  79.    Born  in  Italy.    Age  66  years.    Occupation,  laborer. 

The  dependent's  sister-in-law  stated  that  the  dependent  had  a  bank  account  in  the 
Dime  Savings  Bank,  with  about  $200  to  his  credit.  He  had  been  an  undertaker  and 
at  one  time  had  a  great  deal  of  money. 

Case  80.     A  native  of  Ireland.     Age  64.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien,  who 
had  lived  only  3  months  in  New  York  State.  They  showed  him  to  have  been  in  good 
physical  condition.  At  the  time  of  investigation  it  was  found  that  he  had  been  sent 
to  Massachusetts  by  the  State  Board  of  Charities. 

Case  81.     A  native  of  the  United  States.     Age  47.     Occupation,  ironworker. 

The  investigator  found  that  the  dependent  was  a  non-resident,  and  that  he  had 
been  sent  to  Massachusetts  by  the  State  Board  of  Charities. 

Case  82.    A  native  of  Italy.    Age  76. 

In  the  country  20  years,  but  not  a  citizen.  His  cousin  was  interviewed,  and  said 
that  the  old  man  had  lived  at  their  home  for  a  long  time  but  that  they  "got  tired  of 
keeping  him"  and  sent  him  to  the  Brooklyn  Home.  He  had  been  transferred  to  the 
Colony.  These  people  owned  a  good  barber  shop  but  would  pay  nothing  for  his 
support.  The  Department  of  State  and  Alien  Poor,  of  the  State  Board  of  Charities, 
had  no  record  of  any  request  for  the  investigation  of  this  alien  for  possible  deporta- 
tion. 

Case  83.     A  native  of  the  United  States.     Age  49.     Occupation,  laborer. 

The  dependent  had  been  in  the  Home  13  times,  although  in  1901  a  note  was  en- 
tered on  the  history  of  this  dependent  that  he  was  not  to  be  readmitted.  The  de- 
pendent's sister-in-law  was  interviewed.  She  said  that  his  4  brothers  were  all  able 
to  take  care  of  him,  and  if  they  would  do  their  share  in  clothing  him  she  would  be 
willing  to  maintain  him  in  her  own  home. 

Case  84.    A  native  of  Ireland.    Age  61  or  over.     Occupation,  laborer. 

When  investigated  it  was  found  that  this  dependent  was  living  with  his  sister, 
who  was  willing  and  able  to  keep  him. 

Case  85.    A  native  of  England.    Age  50. 

It  was  found  that  he  was  not  an  American  citizen,  and  that  he  lived  in  an  ex- 
pensively furnished  apartment.  He  had  a  son  in  the  office  of  the  New  York  Taxicab 
Co.,  earning  $15  a  week,  and  a  daughter,  who  earned  $15  a  week  as  a  bookkeeper. 
The  dependent's  wife  earned  $10  a  week  by  sewing.  He  was  crippled  and  partially 
paralyzed.  As  soon  as  the  family  heard  that  the  dependent  was  in  this  Home  the  son 
took  him   out. 

Case  86.     A  native  of  Russia.     Age  33.     Occupation,  carpenter. 

A  friend  was  seen  who  said  that  the  family,  consisting  of  husband,  wife,  and 
3  children,  had  lived  at  the  address  given.  The  husband  became  sick  and  went  to  a 
municipal  hospital  for  treatment.  He  claimed  that  he  left  because  he  got  no  care. 
This  friend  could  not  tell  the  nature  of  his  sickness  but  said  that  he  and  his  wife 
were  both  sick  at  the  time  of  the  interview,  6  months  after  his  discharge  from  the 
Home.  The  Home  records  showed  this  dependent  to  have  been  an  alien.  His  parents 
were  in  Russia. 

Case  87.    A  native  of  Germany.     Age  66.     Occupation,  janitor  or  ironworker. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
The  investigators  found  that  the  dependent's  friends  were  unknown  at  the  address 
given. 

Case  88.    A  native  of  Italy.    Age  48.    Occupation,  laborer. 

This  case  was  referred  to  the  State  Board  of  Charities,  and  the  dependent  and  his 
family  of  4  were  removed  to  Nevv  Britain,  Conn.  The  Home  records  showed  a  resi- 
dence of  only  3  weeks  in  the  United  States. 

Case  89.    A  native  of  Germany.     Age  61   or  over.     Occupation,  butcher. 

A  friend  of  this  dependent  said  that  he  was  a  veteran  and  received  a  pension. 
The  Colony  records  showed  that  he  was  in  good  condition  and  able  to  work. 


334  HOSPITAL   COMMITTEE 

Case  go.     A  native  of  Russia.     Age  27.     Occupation,  ironer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
They  also  showed  that  he  was  in  good  physical  condition  and  able  to  work.  It  was 
learned  at  the  State  Board  of  Charities  that  he  had  been  sent  back  to  Russia. 

Case  91.    A  native  of  Gfermany.     Age  58  or  over.     Occupation,  bookbinder. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
They  also  showed  that  he  was  in  fair  physical  condition  and  could  do  light  work. 

Case  92.    A  native  of  Russia.     Age  24.     Occupation,  cabinet-maker. 

The  Home  records  showed  that  this  dependent  had  been  only  15  months  in  the 
United  States.  They  showed  him  to  be  in  good  condition  and  able  to  work.  When 
investigated  it  was  found  that  he  had  been  sent  back  to  Russia  by  the  State  Board 
of  Charities. 

Case  93.     A  native  of  the  United   States.     Age  18.     A  school-boy. 

This  inmate  had  been  in  a  hospital  in  Philadelphia  and  was  to  have  been  sent  to 
an  almshouse  there.  The  father  of  the  patient,  on  hearing  of  the  proposed  removal, 
brought  the  boy  to  New  York  and  had  him  admitted  to  the  City  Home.  The  boy 
was  told  to  state  on  admission  that  his  residence  was  in  New  York.  Investigation 
developed  that  the  father  was  also  a  non-resident,  and  that  the  State  Board  of  Chari- 
ties had  the  case  and  the  dependent  was  to  be  returned  to  Philadelphia  by  them. 
The  boy  claimed  a  5  months  residence  in  the  State,  according  to  the  entry  made 
at  the  Home  at  the  time  of  his  admission. 

Case  94.    A  native  of  Ireland.     Age  51  or  over.     Occupation,  stableman. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
They  also  showed  him  to  be  able  to  work  but  that  he  was  out  of  employment  at  the 
time  of  admission.     He  had  no  relatives  in  this  country. 

Case  95.    A  native  of  Belgium.     Age  69.     Occupation,  laundryman. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  The 
records  showed  him  to  be  in  good  condition  and  able  to  work.  When  investigated 
it  was  found  that  the  addresses  given  were  old,  and  that  the  dependent  had  not  been 
seen  for  several  years. 

Case  96.     A  native  of  Ireland.     Age  74.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
Investigation  proved  that  a  false  address  had  been  given  for  his  friend.  No  residence 
was  given  for  himself. 

Case  97.    A  native  of  Ireland.    Age  68.     Occupation,  laborer. 

The  Home  records  showed  this  dependent  to  be  a  non-resident,  only  4  days  in 
the  city,  in  good  physical  condition  and  able  to  work.  He  had  a  brother  living  in 
New  Jersey. 

Case  98.    A  native  of  Russia.     Age  74.     Occupation,  baker. 

A  widower,  with  2  sons  and  2  married  daughters.  One  of  his  daughters  said 
that  he  was  an  alien.    This,  fact  also  appeared  on  the  City  Home  record. 

Case  99.     A  native  of  Scotland.     Age  66.     Occupation,  stonecutter. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
The  investigators  found  that  the  dependent  and  his  wife  were  both  unknown  at  the 
addresses  given. 

Case  100.    A  native  of  the  United  States.     Age  31.     Occupation,  housewife. 

At  the  time  of  investigation  an  aunt  said  that  the  dependent  owned  property  with 
equity  worth  $2,500.  She  had  heard  that  the  dependent  was  at  another  public  insti- 
tution, where  her  husband  was  paying  for  her. 

Case  ioi.     A  native  of  Ireland.     .\ge  26.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
They  also  showed  that  he  was  physically  able  to  work  but  that  he  had  been  out  of 
employment  at  the  time  of  admission. 


ADMISSIONS   TO   CITY  HOMES  335 

Case  102.     A  native  of  the  United  States.     Age  54.     Occupation,  harness-maker. 

The  Home  records  showed  that  the  dependent  was  a  non-resident  who  had  been 
in  the  State  only  4  days.  They  also  showed  that  he  was  in  good  condition  and 
able  to  work.  When  investigated  it  was  found  that  he  had  been  sent  to  Connecticut 
by  the  State  Board  of  Charities. 

Case  103.     A  native  of  Ireland.     Age  66  or  over.     Occupation,  cook. 

The  Colony  records  showed  that  this  dependent  was  well  and  able  to  work 
but  that  he  was  out  of  employment  at  the  time  of  admission.  He  left  the  Colony  to 
engage  in  work. 

Case  104.     A  native  of  the  United  States.     Age  67.     Occupation,  carpenter. 

The  dependent  had  a  wife  and  daughter  living  but  had  been  out  of  touch  with 
them  for  a  long  time.  A  friend  was  interviewed  who  said  that  the  wife  and  daugh- 
ter were  in  good  circumstances  but  had  left  him  dependent  upon  a  cousin  for  years. 

Case  105.    A  native  of  Holland.     Age  53.     Occupation,  farmhand. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  transferred  to  the  payroll  at  the  Colony,  although  he  received  small  sums  of 
money  from  Holland. 

Case  106.    A  native  of  Ireland.     Age  60.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
There  were  3  entries  of  admissions  of  this  dependent. 

Case  107.    A  native  of  England.    Age  66.     Occupation,  actor. 

The  Home  records  showed  that  the  dependent  had  been  in  the  United  States 
only  2  months  and  that  he  was  in  good  condition.  It  was  found  that  the  State 
Board  of  Charities  had  sent  him  back  to  England. 

Case  108.     A  native  of  Ireland.     Age  Z7-     Occupation,  waiter. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 

Case  109.     A  native  of  Ireland.     Age  58,     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
Neither  the  dependent  nor  his  friends  were  known  at  the  addresses  given  for  them 
on  the  Home  records. 

Case  no.    A  native  of  Germany.    Age  59  or  over.    Occupation,  baker. 

Unmarried.  The  entry  on  the  Home  records  showed  that  the  dependent  was  not 
a  citizen  and  had  been  admitted  to  the  Home  6  times. 

Case  hi.     A  native  of  Ireland.     Age  45.     Occupation,  waiter. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
A  friend  said  that  the  dependent  was  destitute  and  without  relatives  in  the  United 
States. 

Case  112.    A  native  of  Ireland.     Age  59.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  a  widower.    A  friend  said  that  he  was  lame  but  able  to  work. 

Case  113.    A  native  of  the  United  States.     Age  22.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  a  non-resident  who  had  been 
in  the  State  only  3  months.  They  also  showed  him  to  be  in  good  physical  condition 
and  able  to  work. 

Case  114.    A  native  of  Ireland.     Age  21.     Occupation,  laborer. 

Unmarried.  This  dependent  was  reported  to  the  State  Board  of  Charities  and 
was  to  have  been  deported  by  them.  Upon  the  dependent's  sister  interceding  with 
the  State  Board  of  Charities  he  was  discharged  in  her  custody,  with  the  understand- 
ing that  if  he  returned  to  the  institution  again  he  would  be  deported.  The  depen- 
dent's history  at  the  Home  showed  that  he  was  an  alien,  only  14  months  in  the 
United  States,  and  that  he  was  admitted  twice  to  this  Home ;  that  he  entered  the 
first  time  as  a  case  for  investigation  by  the  State  Board  of  Charities,  and  was  dis- 
charged the  second  time  by  order  of  the  Superintendent  of  the  Department  of  State 
and  Alien  Poor  of  the  Board. 


336  HOSPITAL   COMMITTEE 

Case  115.     A  native  of  Ireland.     Age  64  or  over.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
When  investigated  it  was  found  that  the  dependent  and  his  friends  were  all  unknown 
at  the  addresses  given. 

Case  116.    A  native  of  Ireland.     Age  67.     Occupation,  moulder. 

The  investigators  found  this  dependent  to  be  an  unnaturalized  alien.  They  also 
found  that  he  had  relatives  ready  to  support  him  but  that  he  would  not  remain  with 
them.     A  relative  considered  him  feeble-minded. 

Case  117.    A  native  of  the  United  States.     Age  44.     Occupation,  driver. 

He  lived  for  some  time  with  his  brother.  The  latter's  wife  said  that  she  and 
her  husband  have  a  home  for  the  dependent  as  long  as  he  behaves  himself.  He  had 
another  brother  in  New  York  who  was  in  good  circumstances  and  would  keep  him 
if  he  did  not  make  himself  a  nuisance.  The  sister-in-law  said  that  she  had  not  seen 
the  dependent  since  the  previous  May,  when  she  saw  him  in  the  Brooklyn  Home.  Her 
daughter  was  carrying  a  burial  insurance  for  him.  This  family  and  the  brother  in 
New  York  might  be  willing  to  pay  for  his  care. 

Case  iiS.    A  native  of  Ireland.     Age  54.     Occupation,  horseshoer. 

His  wife  and  children  lived  in  Brooklyn.  The  wife  was  not  found  at  home,  as 
she  goes  out  working  daily.  The  children  were  in  school.  The  housekeeper  was  seen, 
and  said  that  the  man  was  a  blacksmith,  and  could  work  and  support  his  family.  The 
wife  was  obliged  to  take  care  of  her  children,  and  thought  that  her  husband  should 
be  compelled  to  do  something  for  her. 

Case  119.    A  native  of  Ireland.     Age  21.     Occupation,  engineer. 

The    Colony   records    showed   that   this   dependent   was    an    unnaturalized   alien. 

Case  120.    A  native  of  Ireland.     Age  25.     Occupation,  fireman. 

The  Colony  records  showed  that  this  dependent  was  an  alien  who  had  been  in 
the  United  States  only  4  years,  and  in  New  York  State  only  3  days.  The  records 
also  showed  that  he  was  able  to  work. 

Case  121.     A  native  of  Russia.     Age  28.     Occupation,  mattress-maker. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  unmarried.  This  case  was  referred  to  the  State  Board  of  Charities  and 
closed  by  them  without  any  action  having  been  taken. 

Case  122.     A  native  of  Ireland. 

This  dependent  had  been  in  the  United  States  50  years  and  is  a  citizen.  He  had 
been  ill  for  3  years  and  unable  to  work.  His  wife  stated  that  he  was  a  veteran  and 
in  receipt  of  a  pension. 

Case  123.     A  native  of  France.     Age  78.     Occupation,  engineer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
According  to  the  stepdaughter  the  2  sons  had  been  paying  their  father  $io  per  month 
for  several  years. 

Case  124.     A  native  of  Russia.     Age  19.     Occupation,  kitchenman. 

This  case  was  referred  to  the  State  Board  of  Charities  and  closed  by  them  with- 
out any  action  having  been  taken.  The  dependent's  history  at  tlie  Home  showed 
that  he  was  a  homeless  and  friendless  alien,  of  only  6  months  residence  in  New 
York  City. 

Case  125.    A  native  of  Russia.     Age  46.     Occupation,  painter. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
His  brother-in-law  said  that  he  was  in  good  physical  condition  but  entered  the  Horne 
on  account  of  a  broken  arm.  He  returned,  at  private  expense,  to  Russia,  where  his 
wife  and  children  live. 

Case  126.    A  native  of  the  United  States.    Age  22.     Occupation,  laborer. 

This  dependent  was  a  non-resident  who  had  been  in  the  State  only  3  months, 
according  to  the  Home  records.  They  also  showed  him  to  be  in  good  condition  and 
able  to  work. 


ADMISSIONS   TO    CITY   HOMES 


337 


Case  127.     A  native  of  Russia.    Age  45.     Occupation,  laborer. 

This  case  could  not  be  investigated,  as  the  address  given  was  a  lodging-house.  The 
history  record  of  this  dependent  showed  that  he  was  not  a  citizen. 

Case  128.     A  native  of  Ireland.    Age  66.    Occupation,  cooper. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 

Case  129.     A  native  of  Germany.    Age  49.     Occupation,  peddler. 

The  dependent's  wife  was  interviewed.  She  stated  that  he  had  been  crippled  10 
years,  and  left  home  to  go  to  a  hospital  for  treatment.  She  learned  that  he  had  been 
transferred  and  went  to  bring  him  home.  About  the  same  time  the  dependent's 
daughter  learned  where  he  was,  and  she  took  him  out.  She  was  supporting  him  at 
the  time  of  the  investigation.  The  wife  was  willing  to  support  him  if  he  wished  to 
return  to  her.     He  appeared  on  the  record  of  the  Home  as  an  alien. 

Case  130.    A  native  of  Russia.     Age  42.     Occupation,  paper-box  maker. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  crippled  from  locomotor  ataxia.  He  had  8  children,  2  of  whom  were  working 
at  $6  a  week. 

Case  131.     A  native  of  Ireland.     Age  62.     Occupation,  kitchenman. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  without  relatives  or  friends  in  the  United  States. 

Case  132.    A  native  of  Germany.     Age  59  or  over.    Occupation,  furrier. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  admitted  7  times  to  the  Home,  and,  when  investigated,  it  was  found  that 
the  dependent  was  unknown  at  the  address  given. 

Case  133.     A  native  of  Ireland.    Age  57.     Occupation,  packer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
The  dependent  was  found  to  be  living  upon  the  bounty  of  his  son.  His  wife  also 
was  working  by  the  day. 

Case  134.     A  native  of  Wales.     Age  52.     Occupation,  janitor. 

The  dependent's  wife  was  able  to  keep  him  in  a  private  hospital  as  a  paying  pa- 
tient for  9  months,  and,  when  she  found  he  did  not  like  the  Home,  took  care  of  him 
at  home  until  he  died. 

Case  135.    A  native  of  Holland.    Age  44  or  over.     Occupation,  butcher. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien  and 
was  admitted  to  the  Home  9  times.  He  was  unmarried  and  had  no  relatives  in  the 
United  States.     He  received  small  sums  of  money  from   Holland. 

Case  136.    A  native  of  Ireland.    Age  45.    Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
They  also  showed  him  to  be  a  cripple. 

Case  137.     A  native  of  Germany.    Age  60.     Occupation,  houseman. 

This  case  had  been  referred  to  the  State  Board  of  Charities  and  the  dependent 
had  been  deported  by  them  to  Sweden.  He  had  afterward  returned  to  the  United 
States  and  was  detained  in  Philadelphia. 

Case  138.    A  native  of  Ireland.     Age  68.     Occupation,  laborer. 

The  dependent  was  living  with  his  son,  who  was  supporting  him.  He  said  he 
had  left  the  Home  because  he  was  required  to  work  and  could  not  do  so  because  of 
rheumatism,  and  that  for  the  same  reason  he  was  unable  to  work  now.  The  record 
at  the  Home  showed  2  admissions  of  this  dependent. 

Case  139.     A  native  of  England.     Age  46.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  was  without  relatives  or  friends  in  the  United  States. 


338  HOSPITAL   COMMITTEE 

Case  140.    A  native  of  the  United  States.    Age  64.     Occupation,  laborer. 

The  Colony  records  showed  that  this  dependent  was  able  to  work  but  that  he  was 
out  of  employment  at  the  time  of  admission.  When  investigated  it  was  found  that  the 
dependent  was  working.  His  wife  said  that  they  had  property  and  intended  to  trade  it 
for  an  apartment  costing  $6,700. 

Case  141.     A  native  of  the  United  States.     Age  45.     Occupation,  boilerman. 

The  Home  records  showed  that  this  dependent  was  a  non-resident,  having  been 
in  the  State  only  4  weeks.  He  was  a  cripple.  It  was  found  that  the  State  Board  of 
Charities  had  sent  him  to  Illinois. 

Case  142.     A  native  of  Russia.     Age  24.     Occupation,  waiter. 

An  unnaturalized  alien,  who  had  been  in  New  York  State  only  2  months,  accord- 
ing to  the  Colony  records.  It  was  also  shown  that  he  was  able  to  work  but  was 
out  of  employment  at  the  time  of  admission. 

Case  143.     A  native  of  England.    Age  58.     Occupation,  waiter. 

A  sister  said  that  this  dependent  made  good  wages  when  he  worked  but  that  he  was 
a  heavy  drinker.     She  said  the  dependent  was  at  work  at  the  time  of  investigation. 

Case  144.    A  native  of  the  United  States.    Age  28.    Occupation,  furnace-setter. 

This  dependent  was  a  non-resident,  having  been  in  the  State  only  2  days,  ac- 
cording to  the  Home  records.  They  showed  him  to  be  in  good  condition  and  able 
to  work.  Investigation  found  that  he  had  been  sent  to  his  wife  in  Kentucky  by  the 
State  Board  of  Charities. 

Case   145.    A  native  of  Italy.     Age  30.     Occupation,  hair-worker. 

This  case  was  referred  to  the  State  Board  of  Charities  and  closed  by  them  with- 
out any  action  having  been  taken.  The  Home  records  showed  this  dependent  t6  have 
been  an  alien. 

Case  146.    A  native  of  Italy.     Age  68.     Occupation,  peddler. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
At  the  time  of  investigation  it  was  found  that  the  dependent  was  unknown  at  the 
address  given. 

Case  147.    A  native  of  the  United  States.     Age  56.     Occupation,  laborer. 

A  friend  said  that  this  dependent  had  a  father  in  New  Jersey  who  was  well-to- 
do.    The  dependent  was  a  cripple. 

Case  148.     A  native  of  Germany.    Age  40.     Occupation,  baker. 

The  Colony  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
The  investigators  found  that  both  the  dependent  and  a  friend  were  unknown  at  the 
addresses  given. 

Case  149.     A  native  of  Italy.     Age  62.     Occupation,  fruit  peddler. 

The  husband  of  the  dependent's  stepdaughter  was  interviewed.  He  and  his  wife 
said  that  they  were  willing  to  support  the  dependent.  The  former  appeared  to  be 
doing  a  good  business  as  a  shoemaker  and  able  to  maintain  the  dependent. 

Case  150.     A  native  of  the  United  States.     Age  52.     Occupation,  driver. 

A  sister-in-law  said  that  the  dependent  lived  with  them  in  Brooklyn  when  he  was 
behaving  himself.  She  said  that  he  had  a  brother  in  New  York  in  good  circumstances. 
A  nephew  said  that  the  dependent  was  a  "big,  husky  fellow,"  and  able  to  work.  He 
was  unmarried. 

Case  151.    A  native  of  Russia.     Age  45.     Occupation,  peddler. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
They  also  showed  him  to  be  a  cripple  and  unable  to  work.  The  investigators  were 
unable  to  locate  either  the  dependent  or  his  friend  at  the  addresses  given. 

Case  152.    A  native  of  Italy.     Age  30.     Occupation,  hair-worker. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
This  was  confirmed  by  an  interview  with  him.  He  was  found  working  for  his 
brother.  His  wife  was  also  earning  enough  for  the  support  of  herself  and  the  chil- 
dren.   The  records  showed  2  admissions  of  this  dependent. 


ADMISSIONS   TO   CITY  HOMES  339 

Cask  153.    A  native  of  Ireland.     Age  63.     Occupation,  shoemaker. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
A  friend  who  said  he  had  seen  the  dependent  about  a  month  after  his  discharge  said 
that  he  seemed  to  be  in  good  health  and  able  to  work  to  earn  his  own  support.  The 
records  showed  2  admissions  of  this  dependent.     He  was  unmarried. 

Case  154.     A  native  of  Germany.    Age  72.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
They  also  showed  him  to  be  in  good  condition  and  able  to  work.  The  dependent's 
friend  was   unknown  at  the  address  given. 

Case  155.    A  native  of  Germany.    Age  70. 

The  dependent  lived  with  his  son.  The  latter  said  that  the  dependent  left  his 
house  of  his  own  accord  and  went  to  the  Home.  He  also  said  that  he  could  not 
pay  for  the  dependent's  maintenance  there,  but  that  if  he  was  willing  to  take  his  place 
in  his  home,  and  not  annoy  the  children  when  they  wanted  to  play,  he  could  come  back. 

Case  156.     A  native  of  Germany.    Age  65.    Occupation,  cigar-maker. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien  who 
had  been  in  the  United  States  only  6  weeks.  They  also  showed  him  to  be  in  good 
condition  and  able  to  work.  It  was  learned  that  the  State  Board  of  Charities  had 
sent  the  dependent  to  Canada. 

Case  157.    A  native  of  Austria.     Age  26.     Occupation,  waiter. 

The  Home  records  showed  that  this  dependent  was  an  alien  who  had  been  in  the 
United  States  only  9  months.  It  was  also  shown  that  he  was  in  good  condition  and  able 
to  work.  When  investigated  it  was  learned  that  he  had  been  sent  back  to  Austria 
by  the  State  Board  of  Charities. 

Case  158.     A  native  of  Ireland. 

The  dependent  had  been  in  this  country  60  years  and  was  a  citizen.  His  daughter 
said  her  husband  had  a  music  store.  Her  father  had  visited  her  for  a  short  time,  and 
she  had  not  known  that  he  was  in  the  Home.  No  inquiry  about  her  father  had  ever 
been  made  by  the  Department  of  Charities.  She  thought  that  the  dependent  was  work- 
ing in  New  York,  and  did  not  think  that  she  should  support  him.  She  gave  the  name 
of  another  daughter  living  in  New  York  City.  Inquiry  was  made  at  this  daughter's 
address,  where  the  janitor  said  that  the  family  had  moved  and  that_  the  son-in-law 
had  held  a  city  position  paying  $3,600.  The  City  Record  showed  this  man  to  be  a 
clerk,  receiving  a  salary  of  $2,850,  increased  from  $2,700  within  a  year. 

Case  159.    A  native  of  Ireland.     Age  72. 

His  widow  said  that  he  had  become  quite  feeble,  and  that  in  going  for  his  daily 
walk  one  day  he  disappeared.  After  3  days  she  located  him  at  Kings  County  Hospital. 
He  seemed  pretty  well  at  the  time,  but,  upon  advice  of  the  doctor,  she  left_him_  there. 
She  went  back  a  week  later  and  found  him  in  the  almshouse  hospital,  sick  in  bed. 
He  had  just  received  extreme  unction.  She  brought  him  home  in  an  ambulance, 
July  18,  and  he  died  July  24,  1912.  The  widow  said  she  received  no  word  from  the 
Bureau  of  Dependent  Adults  or  from  the  Home  that  he  had  been  sent  either  to  the 
Hospital  or  the  Home,  and  she  only  learned  of  his  whereabouts  by  going  to  the  Dep- 
uty Commissioner's  office  and  getting  some  one  to  run  over  the  permit  stubs  until 
he  found  the  address  of  the  dependent's  home  entered  on  one  of  them.  The  family 
would  never  have  allowed  him  to  become  a  City  charge  had  they  been  able  to  pre- 
vent it. 

Case  160.     A  native  of  Italy.     Age  69.     Occupation,  barber. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
They  also  showed  him  to  be  in  good  condition  and  able  to  work.  When  investi- 
gated it  was  found  that  the  dependent  had  asked  to  be  discharged  because  he  did 
not  like  the  Home,  and  that  he  was  then  making  about  $20  per  week  in  a  barber 
shop,  with  no  one  dependent  upon  him. 

Case  161.    A  native  of  the  United  States.     Age  34.     Occupation,  orderly. 

The  residence  given  was  a  lodging-house  and  saloon,  and  the  inmate  could  not 
be  located.     However,  his  brother,  a  former  assemblyman,  now  on  the  editorial  staflc 


340  HOSPITAL    COMMITTEE 

of  a  newspaper,  was  seen  in  his  office.  He  said  that  his  brother  was  a  single  man, 
whose  father  and  mother  were  dead.  Some  years  before  he  had  had  an  accident, 
breaking  his  kneecap.  He  went  to  pieces  after  that  and  had  been  a  disgrace  to  the 
family.  The  brother  had  offered  repeatedly  to  place  him  in  a  good  political  posi- 
tion if  he  would  straighten  up.  The  brother  also  said  he  would  do  anything  he  could 
for  his  maintenance  that,  was  proper  to  do,  and  that  there  was  no  reason  why  he 
should  have  applied  for  relief  in  Brooklyn. 

Case  162.     A  native  of  Russia.     Age  31.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  It 
was  also  shown  that  he  had  rheumatism  and  could  not  work.  When  investigated  it 
was  learned  that  he  had  been  sent  back  to  Russia  by  the  State  Board  of  Charities. 

Case  163.     A  native  of  Italy.     Age  72.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  He 
was  unmarried.  A  niece  of  the  dependent  was  interviewed  and  she  claimed  that  he 
was  destitute.    He  was  still  in  the  Home  after  a  stay  of  6  months. 

Case  164.    A  native  of  England.     Age  76. 

He  claimed  to  have  been  naturalized.  His  niece  was  seen  and  said  that  the  de- 
pendent had  a  son,  a  mechanic,  earning  about  $18  per  week  when  at  work.  The 
question  of  support  of  the  dependent  was  taken  into  court  and  the  judge  told  the  son 
that  he  must  pay  $3  a  week  to  the  father.  This  amount  would  cover  the  weekly 
expense  for  the  dependent  in  the  Home,  according  to  the  estimated  expense  per  de- 
pendent, published  in  the  annual  reports  of  the  Department  of  Public  Charities. 

Case  165.    A  native  of  Germany.     Age  50  or  over.     Occupation,  blacksmith. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  At 
the  time  of  investigation  no  residence  was  found  at  the  address  given  for  the  de- 
pendent. 

Case  166.    A  native  of  Ireland.     Age  53. 

His  wife,  at  the  residence  address  given,  said  that  he  had  left  her  in  May,  on  the 
date  of  his  admission  to  the  Home,  saying  that  he  was  going  to  a  hospital.  She  had 
telephoned  to  Kings  County  Hospital  and  got  word  that  he  was  not  there.  She 
said  that  he  was  an  able-bodied  man  and  should  support  his  family.  When  told  by 
the  investigator  that  he  was  in  the  Home  she  said  that  she  would  get  him  out,  as 
there  was  no  reason  for  him  to  be  a  dependent. 

Case  167. 

A  neighbor  stated  that  the  dependent  was  a  soldier's  widow  and  received  a 
pension  of  $36  every  3  months.    Her  niece  had  all  the  papers  relating  to  the  pension. 

Case  168.    A  native  of  Ireland. 

At  the  son's  address  no  response  was  made  to  knocks  at  the  apartment  door,  al- 
though 3  visits  were  made.  A  neighbor  said  the  people  were  at  home  and  would 
not  open  the  door,  and  also  reported  that  the  2  sons  and  a  sister  were  all  employed. 

Case  169.    A  native  of  Ireland.    Age  72. 

He  had  been  in  the  United  States  35  years  but  his  citizenship  was  not  known 
to  the  person  interviewed.  His  niece's  husband  said  that  the  dependent  was  not  able 
to  work,  and  that  he  and  his  wife  were  willing  to  keep  him  if  he  would  return  to 
them.  The  man  interviewed  made  a  fair  living  and  had  no  one  but  his  wife  de- 
pendent upon  him. 

Case  170.    A  native  of  England.     Age  30.     Occupation,  draughtsman. 

The  Home  records  showed  that  this  dependent  was  a  non-resident  who  had  been 
in  the  State  only  3  weeks.  They  also  showed  that  he  was  in  a  good  condition  ajid  able 
to  work.  When  investigated  it  was  found  that  the  State  Board  of  Charities  had 
sent  him  to  Illinois. 

Case  171.    A  native  of  Ireland.    Age  70. 

The  dependent  was  seen  at  the  home  of  her  daughter  and  said  that  she  had 
lived  there,  but  had  felt  she  ought  to  go  to  the  Home  instead  of  being  a  burden  upon 
her  daughter.  The  rooms  were  well  furnished  and  well  kept.  The  daughter  said 
that  she  always  had  a  home  for  her  mother. 


ADMISSIONS   TO    CITY   HOMES  34I 

Case  172.     A  native  of  Norway.     Age  36. 

The  dependent  had  been  in  the  country  S  years  but  had  never  filed  citizenship 
papers.  The  dependent,  and  also  a  friend,  who  was  acquainted  with  the  illness 
which  led  to  the  dependent's  admission  to  the  Home,  were  seen.  These  2  men  had 
been  working  in  North  Carolina.  Both  had  become  sick  with  malaria,  and  the  de- 
pendent returned  here  and  went  to  Kings  County  Hospital.  Since  then  he  had  had  no 
treatment,  and,  on  the  24th  of  September,  after  refusing  to  be  transferred  to  the 
Colony,  he  was  discharged  from  the  Home.  He  said  his  eyes  were  failing  and  that 
his  hearing  was  becoming  defective.  The  Department  of  State  and  Alien  Poor  of  the 
State  Board  of  Charities  had  no  record  of  any  application  having  been  made  for  the 
investigation  of  this  alien  for  possible  deportation. 

Case  173.     A  native  of  Germany.    Age  80. 

A  Jewish  woman,  living  in  Brooklyn.  Her  son  was  seen  in  Manhattan,  where  he 
had  a  prosperous  liquor  business.  He  said  that  he  had  twice  made  arrangements  to 
put  his  mother  in  a  Jewish  Home  for  the  Aged  but  his  sister  was  unwilling  to  have 
him  take  her  there.  A  week  or  so  later  he  had  had  a  summons  from  the  Domestic 
Relations  Court,  where  he  had  made  a  settlement  for  the  payment  of  $8  per  month 
for  his  mother.  This  he  sent  on  the  first  of  each  month  regularly.  If  he  knew  that 
his  mother  would  go  into  a  Jewish  Home  when  the  arrangements  were  made  he  would 
make  another  effort  for  her  and  pay  the  expense  of  her  maintenance  there. 

Case  174.    A  native  of  England.    Age  70.     Occupation,  painter. 

A  friend  of  this  dependent  said  that  he  had  returned  to  England  several  times, 
and  the  last  time  remained  there  about  lyi  years.  She  did  not  know  whether  he  was 
a  citizen  or  not.  The  information  gathered  seemed  to  indicate  that  this  dependent  had 
probably  become  expatriated. 

Case  175.     A  native  of  Ireland.     Age  72. 

At  an  employment  agency  it  was  learned  that  i  of  the  daughters  was  well  able 
to  provide  for  the  dependent,  and  was  willing  to  do  so.  The  dependent's  son  earned 
about  $15  a  week  as  a  cook,  and  was  also  willing  to  provide  for  his  mother.  The 
daughter  owned  a  restaurant.  Another  daughter  said  that  these  2  children  intended 
to  remove  the  mother  from  the  Home  as  soon  as  they  could  find  a  place  for  her.  Cor- 
roboration of  the  statement  that  they  were  willing  to  provide  for  her  was  obtained. 

Case  176.    A  native  of  Ireland.     Age  46. 

Her  former  employer  said  that  the  dependent  had  worked  for  her  and  earned  $10 
a  month.  The  employer  carried  burial  insurance  for  her.  She  hurt  her  foot  and  went 
to  Kings  County  Hospital,  and  after  her  foot  was  well  she  was  transferred  to 
the  Home.  Her  employer  said  that  there  were  no  known  relatives  to  care  for  the  de- 
pendent but  that  she  would  be  very  glad  to  have  her  back,  as  she  was  a  good  worker. 
The  employer  said  she  thought  that  the  dependent  would  rather  leave  the  Home  and 
work  than  be  dependent  on  charity.  When  the  dependent  was  seen  later  at  the  Home 
and  was  told  of  the  opening  she  was  glad  to  accept  it,  and  was  discharged  the  next 
day  to  take  the  position. 

Case  177.     A  native  of  Ireland.    Age  75  years.     Occupation,  laborer. 

A  naturalized  citizen  who  had  served  in  the  U.  S.  navy  and  was  receiving  a  pension 
from  the  U.  S.  Government.  His  daughter-in-law  stated  that  he  had  4  sons  and  2 
daughters  but  that  they  refused  to  care  for  their  father.  The  dependent  had  been 
unable  to  work  for  some  time  before  going  to  the  Home  and  had  been  a  hospital 
patient. 

Case  178.    A  native  of  the  United  States.    Age  75.     Occupation,  laborer. 

His  daughter  said  that  his  son  was  a  first-rate  fireman,  making  $1,400  per  year, 
and  that  he  allowed  the  dependent  $3  per  week.  This  could  have  paid  the  dependent's 
expenses  at  the  Home,  according  to  the  estimate  for  maintenance  published  in  the  an- 
nual reports  of  the  Department  of  Public  Charities. 

Case  179.     A  native  of  Ireland.    Age  60. 

The  family  could  not  be  located,  but  a  woman  with  whom  they  formerly  had 
rooms  was  seen.  She  said  there  was  a  daughter,  who  was  a  good  girl  and  worked 
and  earned  fair  wages,  and  a  son  who  was  steady.  They  paid  the  expenses  of  their 
father  and  mother  when  with  them,  and  she  understood  that  they  were  now  keeping 
up  a  home  for  them  since  the  dependent's  discharge  from  the  Home. 


342 


HOSPITAL    COMMITTEE 


Case  i8o.     A  native  of  Ireland.     Age  75. 

It  was  learned  that  she  owned  a  one-third  interest  in  the  property  at  the  address 
given  as  her  residence,  and  also  owned  lots  in  Long  Island  City.  An  intimate  friend 
said  that  the  stepdaughters  with  whom  the  dependent  lived  sent  her  to  the  Home,  as 
they  worked  and  she  was  feeble  and  could  not  be  left  alone.  The  stepdaughters 
were  seen  and  said  that  they  were  willing  to  pay  the  dependent's  expenses  out  of  the 
estate. 

Case  181.    A  native  of  Germany.     Age  68.     Occupation,  laborer. 

It  was  said  that  i  daughter  and  her  husband  owned  the  house  in  which  they 
lived,  and  were  well  able  to  care  for  their  father.  He  had  left  the  Home  because  his 
children  had  promised  to  pay  for  a  room  for  him. 

Case  182.     A  native  of  Scotland.    Age  63.    Occupation,  clerk. 

This  dependent  was  an  alien  who  had  been  in  the  United  States  only  4  years. 
The  investigators  found  that  the  dependent  was  unknown  at  the  addresses  given. 

Case  183.     A  native  of  Germany.     Age  74.     Occupation,  farm  laborer. 

The  janitress  at  the  dependent's  residence  said  that  his  son  had  removed  to  his  own 
house  at  Coney  Island.  She  said  dependent  also  had  a  son  in  Germany.  The  depen- 
dent's son  was  seen  and  was  found  to  own  his  house. 

Case  184.    A  native  of  the  United  States.     Age  26.     No  occupation. 

The  dependent  was  deaf,  dumb,  and  half  blind.  He  wrote  in  answer  to  written 
questions  that  he  was  a  native  of  New  Jersey,  residing  before  admission  in  that  state, 
and  that  his  brother  brought  him  to  New  York  and  had  had  him  admitted  to  the  Home. 
The  entry  on  the  Home  record  was  that  this  dependent  had  lived  25  years  in  the  city, 
but  his  brother's  address,  at  both  the  Home  and  the  Bureau  of  Dependent  Adults, 
was  given  in  New  Jersey. 

Case  185.    A  native  of  Ireland.    Age  67.     Occupation,  moulder. 

The  investigators  found  this  dependent  to  be  an  alien  who  had  not  been  natural- 
ized. They  also  found  that  he  had  relatives  ready  to  support  him,  but  he  would  not  re- 
main with  them.     A  relative  considered  him  feeble-minded. 

Case  186.    A  native  of  Russia.    Age  20.     Occupation,  dishwasher. 

This  case  was  referred  to  the  State  Board  of  Charities  and  the  dependent  was  re- 
turned to  Russia  by  the  Board.  His  history  at  the  Home  showed  that  he  had  been 
in  the  United  States  only  6  months. 

Case  187.     A  native  of  Norway.    Age  70.    Occupation,  sailor. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  They 
gave  no  definite  address  of  the  residence  and  no  friends. 

Case  188.     A  native  of  the  United  States.     Age  63.     Occupation,  laborer. 

The  landlady  of  the  dependent  said  that  the  dependent  was  a  veteran,  without 
family.    He  was  admitted  to  the  Home  7  times. 

Case  189.    A  native  of  England.     Age  58  or  over.     Occupation,  ironworker. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  None 
of  the  3  addresses  given  as  the  residences  of  the  dependent  and  his  friends  were 
residential. 

Case  190.    A  native  of  the  United  States.    Age  76.    Occupation,  engineer. 

A  friend  stated  that  she  was  willing  to  give  the  dependent  a  home  if  he  would 
watch  the  house  while  they  were  out.  He  had  been  seen  looking  for  employment. 
The  Home  records  showed  S  admissions  there  of  this  dependent. 

Case  191.     A  native  of  Ireland.    Age  76.    Occupation,  blacksmith. 

A  widower.  This  dependent's  daughter  refused  to  give  any  information,  except 
that  it  was  entirely  unnecessary  for  her  father  to  be  in  the  Home.  She  asked  that  he 
be  refused  admission  the  next  time  he  applied  for  it.  The  Home  records  showed  4  ad- 
missions of  this  dependent. 


ADMISSIONS   TO   CITY   HOMES  343 

Case  192.    A  native  of  the  United  States.     Age  62. 

At  the  home  of  her  son  she  said  that  her  son  did  not  live  with  his  wife,  and  that 
she  kept  house  for  him  and  her  grandson.  She  was  taken  to  Kings  County  Hos- 
pital when  she  had  had  a  paralytic  stroke  which  had  crippled  her.  As  soon  as  she 
was  better  she  was  told  that  they  needed  the  bed  and  was  sent  to  the  Home.  Her 
son  took  her  out  at  her  request  and  was  supporting  her. 

Case  193.    A  native  of  Sweden.    Age  62. 

The  occupants  of  the  house  given  as  her  residence  said  that  they  knew  little  about 
her,  except  that  she  had  boarded  with  the  former  occupants,  whose  present  where- 
abouts were  not  known,  and  that  she  was  able  to  work  to  earn  her  own  support. 

Case  194.     A  native  of  the  United  States.     Age  68.     Occupation,  storekeeper. 

This  dependent  was  brought  to  a  hospital  by  ambulance  from  the  Pennsylvania 
R.  R.  Station,  having  just  returned  from  a  stay  of  a  year  and  a  half  in  Toronto,  Can- 
ada. While  in  the  hospital  $1.50  per  day  was  paid  for  the  patient  by  his  son.  The 
patient  was  transferred  to  this  Home,  from  which  place  the  case  was  referred  to  the 
State  Board  of  Charities  for  investigation  for  possible  removal.  Before  the  State 
Board  took  action  on  the  case  they  were  notified  that  the  patient  had  been  admitted 
to  the  Home  through  some  mistake,  and  that  relatives  were  able  and  willing  to  care 
for  the  patient  in  their  own  home.  The  patient  was,  therefore,  discharged  by  order  of 
the  State  Board  to  these  relatives.  The  home  of  these  relatives  gave  every  indica- 
tion that  they  were  prosperous. 

Case  195.    A  native  of  Austria.    Age  53.     Occupation,  presser. 

The  dependent  has  a  son  in  Detroit,  Mich.,  who  is  a  printer  by  trade.  The  Home 
records  have  no  information  regarding  this  dependent's  citizenship,  but  his  wife  said 
that  he  was  not  a  citizen. 

Case  196.     A  native  of  Russia.    Age  31.     Occupation,  painter. 

The  dependent  was  sent  to  California  by  the  State  Board  of  Charities,  as  he  was 
not  only  an  alien,  but  also  a  non-resident  of  New  York  City.  His  wife  and  children 
had  been  in  California. 

Case  197.    A  native  of  Italy,  where  her  husband  still  resided. 

The  dependent  had  2  sons  and  a  daughter  in  the  city.  One  son  has  a  small 
grocery  store  and  the  other  is  a  plasterer  by  trade.  Both  professed  to  have  only 
meager  incomes.  This  dependent  was  not  a  citizen,  although  the  Home  records  had 
no  information  on  this  point,  and  had  been  in  the  United  States  only  4  or  S  years. 

Case  198.     A  native  of  England.    Age  68. 

He  said  he  had  been  in  the  Home  3  months,  and  left  because  he  was  asked  to  go 
to  the  Colony,  as  he  did  not  want  to  go  where  his  relatives  and  friends  could  never 
visit  him.  He  said  that  he  had  had  his  sons  in  court  to  make  them  pay  for  his  sup- 
port but  that  only  I  of  the  sons  had  paid  his  share.  The  dependent  made  25  cents 
a  day  and  lived  with  a  friend.  He  had  2  sons  who  were  employed  in  the  Street 
Cleaning  Department,  and  another  son  who  was  an  officer  for  a  private  philanthropic 
organization. 

Case  199.     A  native  of  Ireland.     Age  61. 

She  had  2  daughters  living  in  Brooklyn.  The  daughter  interviewed  said  that  she 
has  always  kept  her  mother  with  her,  and  was  willing  to  give  her  a  home.  She  said 
that  her  sister  worked  and  earned  $7  or  $8  a  week  in  a  cigar  factory.  Her  husband 
was  quite  willing  to  maintain  his  mother-in-law.  This  daughter  said  that  there  was 
another  daughter  in  New  Jersey  who  was  in  good  circumstances  and  could  help. 

Case  200.     A  native  of  England.    Age  SO- 

The  daughter  said  that  she  was  willing  to  give  her  mother  a  home.  The  daugh- 
ter's husband  was  a  cook,  and  when  he  worked  in  hotels  his  salary  was  about  $100  a 
month.  In  restaurants  it  was  about  $18  a  week.  The  mother  was  not  able  to  do 
much  work.     She  earned  about  $12  to  $16  a  month  as  a  cleaner  in  hotels. 

Case  201.    A  native  of  Italy  and  unnaturalized.     Age  73. 

His  son,  who  had  a  good  barber  shop,  employing  3  barbers,  was  interviewed. 
He  said  that  his  father  was  stricken  on  the  street.  A  policeman  found  him  there  and 
sent  him  to  Kings  County  Hospital.     This  was  on   Monday,  and  on  the   following 


344  HOSPITAL    COMMITTEE 

Friday  they  received  word  from  Kings  County  Hospital  that  he  was  there.  Tlie 
son  located  him  at  the  Brooklyn  Home  and  immediately  brought  him  to  his  own  home, 
where  he  died  a  week  later.  The  son  had  not  been  asked  to  pay  anything  for  his 
father's  maintenance. 

Case  202.     A  native  of  Germany.     Age  66.     Occupation,  cigar-maker. 

The  dependent  lived  for  a  long  time  in  Brewster,  N.  Y.  His  sight  failed  and  he 
came  to  New  York  to  live  with  his  sister,  and  was  with  her  only  4  or  5  months.  Be- 
ing too  old  to  support  anyone  but  herself,  she  was  obliged  to  allow  him  to  become  a 
dependent.  He  was  admitted  to  the  Brooklyn  Home  and  was  discharged  because  of 
his  refusal  to  go  to  Farm  Colony.  He  then  returned  to  Brewster,  N.  Y.,  to  apply 
for  admission  to  the  county  almshouse  there.  His  sister  said  that  he  had  never  had  a 
residence  in  New  York  City. 

Case  203.     A  native  of  Germany.    Age  79. 

Her  granddaughter  was  interviewed  and  said  that  the  dependent  went  to  the 
Home  because  no  one  wanted  to  keep  her.  She  had  been  living  with  her  daughter  at 
this  address,  but,  as  the  husband  had  been  out  of  work,  they  were  in  straits.  The 
dependent  was  in  the  Brooklyn  Home,  and  was  continually  worrying  for  fear  she 
would  be  sent  to  Farm  Colony.  She  said  all  the  old  women  lived  in  fear  of  the 
day  when  it  would  be  their  turn  to  go  there.  When  she  was  ordered  to  go  she  would 
refuse  and  would  then  be  taken  by  another  daughter  who  was  able  to  care  for  her. 
The  families  of  both  of  these  daughters  were  in  ordinary  circumstances  but  able  to 
care  for  the  dependent  in  their  own  homes. 

Case  204.     A  native  of  Germany.     Age  75.     Occupation,  clerk. 

He  had  had  considerable  means  and  had  been  an  architect  in  the  employ  of  one 
of  the  City  departments.  He  was  unfortunate  in  losing  his  money  and  his  son,  the 
only  child,  was  unwilling  to  do  anything  for  him.  The  son  was  a  bookkeeper,  earn- 
ing $15  a  week,  and  supported  the  mother,  who  lived  with  him,  paying  $12  a  month 
rent.  The  old  man  was  living  on  money  that  was  being  sent  to  him  by  a  sister  in 
Germany.  Inquiry  at  his  address  was  made.  It  was  said  there  that  he  went  out  to 
work  in  an  architect's  office  each  day  and  returned  home  every  evening  about  8 
o'clock. 

Case  205.    A  native  of  the  United  States.    Age  67. 

An  old  lady,  whose  son  was  paying  to  the  Domestic  Relations  Court  $1  a  week 
for  her  support.  This  money  was  turned  over  to  her  when  she  called  for  it.  The 
dependent  was  discharged  from  the  Home.  There  was  $3  waiting  for  her  at  the  Do- 
mestic Relations  Court  at  the  time  of  the  investigator's  visit. 

Case  206.     A  native  of  Italy.    Age  64.     Occupation,  laborer. 

This  case  was  referred  to  the  State  Board  of  Charities  and  the  dependent  was 
returned  by  them  to  Italy.  The  Home  record  showed  that  he  was  homeless  and 
friendless. 

Case  207.    A  native  of  Germany.     Age  38.     Occupation,  bartender. 

The  dependent  was  an  alien,  and  had  been  an  inmate  of  an  insane  asylum.  His 
sister-in-law  said  his  wife's  family  would  help  him  if  he  would  only  keep  sober  and 
work. 

Case  208.    A  native  of  Ireland.     Age  71  years.     Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 
He  has  never  been  located  at  the  address  given  on  the  Home  records.  He  was  known 
to  have  been  on  the  tuberculosis  records  of  the  Department  of  Health,  and  has  been 
reported  to  them  as  being  in  the  hospital  several  times.  The  Home  records  showed 
that  the  dependent  has  been  admitted  to  the  Home  18  or  19  times,  his  first  admission 
having  been  in  1903. 

Case  209.    A  native  of  Russia.    Age  90.     Occupation,  peddler. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 

Case  210.    A  native  of  Germany.    Age  75.    Occupation,  ticket  agent. 

At  the  son's  address  it  was  found  that  the  latter  and  his  wife  had  no  children  and 
had  occupied  a  6-room  apartment,  at  $38  per  month  rent. 


ADMISSIONS   TO    CITY   HOMES  345 

Case  211.     A  native  of  Ireland.    Age  54.    Occupation,  laborer. 

A  United  States  citizen  who  had  been  admitted  to  the  Home  8  times.  The 
dependent  was  seen  working  at  the  Home.  He  stated  that  he  was  in  very  good  health, 
and  expected  to  go  out  soon  and  go  to  work  as  longshoreman  or  at  hod-carrying. 
He  looked  strong.    He  was  unknown  at  the  address  given  as  his  residence. 

Case  212.     A  native  of  Germany.    Age  65.     Occupation,  laborer. 

His  wife  said  that  her  husband  was  able  to  work  to  earn  his  support.  She  was 
about  to  take  a  place  as  janitress.  She  claimed  her  husband  had  left  the  Home  because 
he  was  unwilling  to  be  transferred  to  Farm  Colony. 

Case  213.    A  native  of  Germany.    Age  71.    Occupation,  laborer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien. 

Case  214.    A  native  of  Ireland.    Age  76.    Occupation,  laborer. 

This  dependent  was  brought  to  a  municipal  institution  directly  from  a  transatlan- 
tic steamship,  with  $260  on  his  person.  This  case  was  referred  to  the  State  Board  of 
Charities  and  closed  by  them  without  any  action  having  been  taken.  He  had  been  only 
3  days  in  the  State  at  the  time  of  his  admission  to  the  Home,  according  to  the  entry 
made  then. 

Case  215.    A  native  of  Bohemia.    Age  24.     Occupation,  clerk. 

The  Home  records  showed  that  he  was  an  alien  who  had  been  in  the  country  only 
18  months,  and  that  he  was  in  good  physical  condition.  Investigation  developed  the 
fact  that  his  parents  and  immediate  family  were  all  in  Bohemia. 

Case  216.    A  native  of  Germany.     Age  76.    Occupation,  kitchenman. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  He 
was  unmarried,  with  no  relatives  in  the  United  States.  The  investigator  was  unable 
to  locate  him  at  the  address  given. 

Case  217.    A  native  of  Germany.    Age  28.    Occupation,  plumber. 

The  dependent's  former  employer  was  given  as  his  friend  on  the  Home  records. 
He  stated  that  dependent  was  a  good  worker  and  able-bodied  before  entering  the 
army.  He  was  then  paralyzed  on  both  sides.  The  dependent  was  seen  at  the  Home, 
and  stated  that  he  had  been  discharged  for  disability,  acquired  while  serving  as  a  sol- 
dier. His  father  had  7  children  under  14  years  of  age  and  was  unable  to  support  him. 
The  dependent  had  been  admitted  6  times  to  this  institution,  according  to  the  records. 

Case  218.    A  native  of  Germany.    Age  61  or  over.    Occupation,  driver  or  butcher. 

A  friend  of  the  dependent  said  that  he  was  a  veteran  and  received  a  pension. 
The  Home  records  showed  he  was  in  good  physical  condition  and  able  to  work. 

Case  219.    A  native  of  Ireland.    Age  57  or  over.     Occupation,  builder. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  He 
and  his  daughter  were  not  known  at  the  address  given  as  their  residence. 

Case  220.    A  native  of  Germany.    Age  66.     Occupation,  farmer. 

The  Home  records  showed  that  this  dependent  was  an  unnaturalized  alien.  A 
friend  in  charge  of  an  employment  agency  said  that  he  had  often  secured  positions  for 
the  dependent,  but  he  had  never  saved  anything,  being  a  heavy  drinker.  He  was  un- 
married. 

Case  221.     A  native  of  Austria.     Age  54.     Occupation,  laborer. 

A  friend  stated  that  the  dependent  walked  on  crutches  and  was  unable  to  work. 
Up  to  14  or  IS  months  before  he  had  received  a  small  amount  of  money  quarterly 
from  Austria  for  8  or  9  years ;  before  that  the  amount  had  been  larger.  This  friend 
did  not  know  who  sent  it  to  him.  The  dependent's  father,  who  died  about  11  years 
ago,  had  had  a  considerable  amount  of  money.  The  dependent  had  a  daughter  in 
comfortable  circumstances.  She  was  the  wife  of  an  officer  in  the  Austrian  army. 
The  dependent  hesitated  to  return  to  Austria  because  of  the  shock  the  contrast 
between  his  condition  and  the  daughter's  would  cause  her.  The  Home  records  showed 
15  admissions  of  this  dependent. 


346  HOSPITAL    COMMITTEE 

Case  222.     A  native  of  Canada.     Age  64  or  over.    Occupation,  cook. 

A  brother  said  that  the  dependent  was  a  heavy  drinker  and  for  this  reason  could 
not  keep  a  job.  He  has  a  sister  hving  in  Canada  who  is  prosperous.  The  brother 
does  not  know  whether  dependent  is  a  naturalized  citizen  or  not,  and  no  entry  of 
information  on  this  point  was  made  on  the  Home  records. 

Case  223.    A  native  of  the  United  States.     Age  42.    Occupation,  civil  engineer. 

His  brother  said  that  the  dependent  was  transferred  from  the  Home  to  another 
public  institution,  where  his  expenses  had  been  paid,  and  was  to  be  transferred  from 
there  to  a  private  institution.  The  dependent  was  on  the  State  payroll  and  had  inde- 
pendent means.  The  brother  interviewed  was  living  in  an  elevator  apartment  and  ap- 
parently in  very  comfortable  circumstances. 

Case  224.     A  native  of  Hungary.     Age  68.     Occupation,  carpenter. 

This  dependent  and  his  wife  were  seen  at  his  home  address.  He  stated  that  he 
owned  no  property  of  any  kind,  and  was  unable  to  pay.  He  has  been  in  America  a 
good  many  years  but  had  not  become  a  citizen.  The  information  at  the  Home  was  to 
the  effect  that  he  was  an  alien. 


Section   III.— SOME  HOSPITAL   PROBLEMS 

1.  Clinical  Records  in   Bellevue   Hospital 

2.  Autopsy  Findings    in   Bellevue  Hospital  Compared   with 

Clinical  Diagnoses 

3.  Distribution  of  Ward   Space  in  Bellevue  Hospital 

4.  Transfer  of  Patients  to  and  from  Bellevue   Hospital  and 

to  and  from  Kings  County  Hospital 

5.  The   Morgue  Service. 


I.  CLINICAL  RECORDS  IN  BELLEVUE  HOSPITAL 


THE  INVESTIGATION 

BY 

Dr.  L.  L.  Williams 

One  hundred  and  thirty-five  clinical  records  taken  from  the  files  with- 
out selection,  except  as  to  type  of  disease,  were  examined  as  to  their  suffi- 
ciency. An  equal  number  was  taken  from  each  division,  and  a  few  from 
services  not  connected  with  divisions.  Nearly  all  of  these  records  are  his- 
tories of  disease  of  a  serious  type.  It  has  been  noted  in  examining  case 
records  for  other  purposes  that  cases  of  serious  disease  are,  as  a  rule, 
better  written  up;  consequently,  in  taking  the  present  series  for  examina- 
tion and  criticism  any  error  which  may  have  been  made  is  in  favor  of  the 
Hospital.  For  purposes  of  discussion,  the  records  examined  may  be  divided 
into  three  classes :  good,  incomplete,  and  poor. 

The  case  histories  classed  as  good  contained  good  admission  notes, 
including  a  careful  record  of  the  physical  examination;  full  laboratory 
notes  when  required;  clinical  notes  at  reasonably  short  intervals;  nurse's 
daily  notes  and  charts ;  and  histories  which  gave  a  connected  account  of  the 
course  of  the  disease  and  sufficient  indication  of  the  patient's  condition  at 
the  termination  of  treatment. 

Incomplete  records  include,  for  the  most  part,  those  in  which  the  record 
of  examination  upon  admission  was  well  written  but  which  thereafter 
consisted  only  of  nurse's  notes  and  the  usual  chart  of  temperature,  etc., 
bedside  notes  recorded  by  the  interne  being  conspicuous  by  their  absence. 
A  few  of  these  incomplete  records  contained  a  discharge  note,  giving  the 
patient's  condition  at  discharge.  A  statement  of  the  patient's  condition 
at  the  date  of  discharge  was  very  frequently  oinitted.  The  formal  result 
noted  in  the  captions,  "cured,"  "improved,"  "unimproved,"  or  "died,"  is 
scarcely  a  sufficient  statement  of  the  outcome  (except  in  the  case  of  death), 
especially  when  the  result  noted  is  "improved."  When  such  a  notation 
is  made  it  is  obviously  necessary  that  the  condition  at  discharge  be  accu- 
rately described  if  the  clinical  record  is  to  be  of  any  value  in  ascertaining 
the  results  of  treatment.  Another  common  practice  is,  when  a  patient  has 
been  admitted  more  than  once  for  the  same  ailment,  to  refer  to  the  previous 
record  for  an  account  of  his  condition  but  without  giving  the  date  of  previ- 
ous treatment.    Such  a  record  cannot  be  regarded  as  complete. 

The  records  classed  as  poor  were  those  in  which  the  defects  were  so 
serious  that  no  adequate  notion  of  what  had  actually  happened  to  the  pa- 
tient could  be  gathered  from  their  perusal.  Some  defects  noted  were: 
failure  to  note  in  the  initial  record  of  examination  important  conditions 
referred  to  in  the  body  of  the  report ;  absence  of  clinical  notes  by  the  house 
officer,  other  than  the  notes  on  admission,  in  important  cases  remaining  in 
the  Hospital  for  considerable  periods ;  absence  of  clinical  notes  after  impor- 
tant operations,  the  subsequent  course  being  a  matter  of  conjecture  and 
the  question  of  aseptic  healing  or  septic  infection  to  be  inferred  from  the 
nurse's  notes  of  "dressings  changed,"  etc.;  failure  of  the  record  to  justify 
the  diagnosis  given  in  the  caption;  absence  of  any  record  of  important 

351 


352  HOSPITAL    COMMITTEE 

complications  noted  in  caption.  One  record  consisted  of  nothing  except 
the  coroner's  statement  of  the  anatomical  diagnosis. 

Of  the  135  clinical  records  examined,  yy,  or  57  per  cent.,  were  re- 
garded as  good  case  histories.  Some  of  these  were  very  well  written; 
others,  while  showing  minor  defects,  were,  nevertheless,  adequate  descrip- 
tions. All  of  the  records  in  this  class  may  be  regarded  as  creditable  to  the 
institution. 

Forty-one  clinical  records,  or  30  per  cent.,  were  incomplete,  and  17, 
or  13  per  cent.,  were  regarded  as  poor,  these  two  classes  showing  defects 
of  the  types  described  on  the  preceding  page. 

It  is  of  interest  to  observe  that  there  was  a  considerable  difference  in  the 
excellence  of  the  clinical  histories  in  the  several  divisions  of  the  Hospital, 
in  some  divisions  the  percentage  of  good  case  histories  being  much  higher 
than  in  others.  In  Division  (X),  for  example,  there  were  found:  good 
histories,  79  per  cent. ;  incomplete  histories,  18  per  cent. ;  poor  histories,  3 
per  cent.  In  Division  (Y)  there  were:  good  histories,  36.5  per  cent;  in- 
complete histories,  36.5  per  cent. ;  poor  histories,  27  per  cent. 

Such  a  disparity  indicates  either  that  the  internes  in  some  divisions  are 
more  carefully  selected  than  in  others,  or  that  in  certain  divisions  the  re- 
quirements as  to  case  histories  are  more  stringent. 

Of  the  135  clinical  records  examined  and  numbered,  numbers  i  to  77 
were  regarded  as  satisfactory,  and  no  notes  were  taken  except  of  names, 
dates,  diagnoses,  divisions,  and  wards.  Notes  of  the  incomplete  and  un- 
satisfactory case  records,  numbered  78  to  118  and  119  to  135,  respectively, 
are  appended  (names  omitted). 

Case  78.     Chronic  valvular  disease  of  heart. 
Admitted  Jan.  21,  1913.     Discharged  Feb.  8,  1913. 

Good  notes  on  admission ;  good  laboratory  notes ;  remainder  of  record  by 
nurse.    No  discharge  note. 

Case  79.    Tuberculous  abscess  of  neck. 
Admitted  Sept.  16,  1912.     Discharged  Oct.  I.  1912. 

Readmission  note  refers  to  previous  physical  examination ;  date  of  latter  not 
given;  one  clinical  note  Sept.  23;  remainder  of  record  by  nurse;  no  discharge 
note. 

Case  80.    Acute  rheumatic  fever. 
Admitted  Feb.  3,  1913.     Discharged  Feb.  10,  1913. 

Good  admission,  physical  examination,  and  laboratory  notes;  remainder  of 
record  by  nurse. 

Case  81.     Diabetes  mellitus. 
Admitted  Sept.   16,  1912.    Discharged  Oct.  i,  1912. 

Good  record  of  admission  and  physical  examination;  one  subsequent  clinical 
note;  remainder  of  record  by  nurse. 

Case  82.    Burn  of  foot. 
Admitted  Feb.  8,   1913.     Discharged  Feb.  10,  1913. 

Good  record  of  admission  and  physical  examination;  remainder  of  record 
by  nurse. 

Case  83.    Acute  rheumatic  fever. 
Admitted  Jan.  13.  1913.    Discharged  Feb.  9,  1913. 

Good  clinical  record  up  to  Jan.  24;  after  that  date  nurse's  notes  only. 

Case  84.     Acute  bronchitis. 
Admitted  Sept.  17,  1912.     Discharged  Oct.   i,   1912. 

Good  record  of  admission  and  physical  examination;  remainder  of  record 
by  nurse ;  broncho-pneumonia  noted  in  caption  as  a  complication ;  no  notes  of 
physical  examination  after  initial  record. 


CLINICAL   RECORDS  353 

Case  85.     Carcinoma  of  rectum. 
Admitted  Jan.  27,  1913.     Discharged  Feb.  2,  1913. 

Good  record  of  admission  and  physical  examination;  remainder  of  record 
by  nurse. 

Case  86.     Myocarditis. 
Admitted  Jan.  20,  1913.     Discharged  Jan.  30,  1913. 

Good  record  of  admission  and  physical  examination;  record  of  sputum  ex- 
amination; no  further  notes  except  by  nurse. 

Case  87.    Acute  salpingitis. 
Admitted  Jan.  25,  1913.     Discharged  Jan.  28,  1913. 

Notes  of  admission,  physical  examination,  and  discharge  not  very  full;  re- 
mainder of  record  by  nurse. 

Case  88.     Cirrhosis  of  liver. 
Admitted  Sept.  23,  1912.     Discharged  Oct.  3,  1912. 

Good  record  of  admission  and  physical  examination.  Discharge  note:  "Pa- 
tient discharged  from  hospital,  being  relieved  somewhat  of  his  distressing  symp- 
toms, but  still  showing  all  signs  of  his  present  illness."    All  other  notes  by  nurse. 

Case  89.     Acute  rheumatic  fever. 
Admitted  Jan.  4,  1913.     Discharged  Feb.  3,  1913. 

Good  record  of  admission  and  physical  examination.  One  clinical  note  Jan. 
g:  "Rales  persist  in  right  base."  No  other  mention  of  any  lung  ocmplication ; 
remainder  of  record  by  nurse. 

Case  90.    Bronchiectasis. 
Admitted  Feb.  2,  1913.    Discharged  Feb.  7,  1913. 

Good  record  of  admission  and  physical  examination;  good  laboratory  notes; 
remainder  of  record  by  nurse. 

Case  91.     Acute  rheumatic  fever. 
Admitted  Jan.  30,  1913.     Discharged  Feb.  9,  1913. 

Good  record  of  admission,  and  of  physical  and  laboratory  examination;  sub- 
sequent record  by  nurse. 

Case  92.     Chronic  cardiac  valvular  disease. 
Admitted  Sept.  16,  1912.     Discharged  Oct.   i,   1912. 

Good  record  of  admission  and  physical  examination;  all  other  notes  by 
nurse. 

Case  93.     Chronic  cardiac  valvular  disease. 
Admitted  Nov.  27,  1912.     Discharged  Dec.  10,  1912. 

Good  record  of  admission  and  physical  examination;  discharge  note;  re- 
mainder of  record  by  nurse. 

Case  94.     Cellulitis  of  leg. 
Admitted  Sept.  15,  1912.     Discharged  Oct.  3,  igi2. 

Good  record  of  admission,  physical  examination,  and  operation;  remainder  of 
record  by  nurse. 

Case  95.     Chronic  valvular  disease  of  heart. 
Admitted  March  19,  1913.    Discharged  March  24,  1913. 

Good  record  of  admission  and  physical  examination;  remainder  of  record 
by  nurse. 

Case  96.     Chronic  interstitial  nephritis. 
Admitted  Nov.   10,   1912.     Discharged  Nov.   18,   1912. 

Good  record  of  admission  and  physical  examination;  good  discharge  note; 
remainder  of  record  by  nurse. 

Case  97.     Chronic  interstitial  nephritis. 
Admitted  Nov.   16,   1912.     Discharged   Nov.   20,    igi2. 

Good  record  of  admission  and  physical  examination;  remainder  of  record 
by  nurse. 


354  HOSPITAL   COMMITTEE 

Case  98.     Chronic  interstitial  nephritis ;  chronic  alcoholic  poisoning. 
Admitted  Nov.  29,  1912.     Discliarged  Dec.  2,  1912. 

Good  record  of  admission,  and  of  physical  and  laboratory  examinations ;  re- 
mainder of  record  by  nurse. 

Case  99.     Chronic  interstitial  nephritis ;  chronic  alcoholism ;  multiple  neuritis. 
Admitted  Nov.  25,  1912.     Discharged  Dec.  11,  1912. 

Good  record  of  admission,  physical  examination,  and  laboratory  notes;  re- 
mainder of   record   by  nurse. 

Case  100.     Chronic  interstitial  nephritis. 
Admitted  Dec.  4,  1912.     Discharged  Dec.  10,  1912. 

Good  record  of  admission,  and  of  physical  and  laboratory  examinations;  re- 
mainder of  record  by  nurse. 

Case   ioi.     Chronic  interstitial  nephritis;   simple  anemia;   general  arterio-sclerosis. 
Admitted  Dec.  2,   1912.     Discharged  Dec.  9,   1912. 

Good   record   of   admission    and   physical   examination;    all   other   notes   by 
nurse. 

Case  102.     Chronic  interstitial  nephritis. 
Admitted  Dec.  6,  1912.     Discharged  Dec.  9,  1912. 

Good  laboratory  notes ;  physical  examination  notes  do  not  mention  a  wound 
of  the  head  referred  to  in  nurse's  note  of  Dec.  6. 

Case  103.     Chronic  valvular  disease  of  heart. 
Admitted  Nov.  4,  1912.     Discharged  Nov.  ig,  1912. 

Good  notes  of  admission  and  physical  examination;  remainder  of  record  by 
nurse. 

Case  104.     Chronic  valvular  disease  of  heart 
Admitted  Oct.  31,  1912.     Discharged  Nov.  20,  1912. 

Good    record   of   admission    and   physical   examination;    all    other   notes   by 
nurse. 

Case  105.     Chronic  valvular  disease  of  heart. 
Admitted  Nov.  24,  1912.     Discharged  Nov.  26,  1912. 

Good  record  of  admission,  and  of  physical  and  laboratory  examinations;  re- 
mainder of  record  by  nurse. 

Case  106.     Chronic  valvular  disease  of  heart. 
Admitted  Nov.  12,  1912.     Discharged  Nov.  22,  1912. 

"Family  history — see  Record  Room."     Date  of  previous  treatment  not  given; 
othervifise  a  good  case  history. 

Case  107.     Chronic  valvular  disease  of  heart. 

Admitted   Nov.    19,   1912.     Discharged   Nov.  25,   1912. 

Good  record  of  admission,  and  of  physical  and  laboratory  examinations;  dis- 
charge note;  all  other  notes  by  nurse. 

Case  108.     Chronic  valvular  disease  of  heart. 
Admitted  Nov.  21,  1912.     Discharged  Nov.  30,  1912. 

Good  record   of  admission,  physical  examination,  and  laboratory  notes;   re- 
mainder of  record  by  nurse. 

Case  109.     Chronic  valvular  disease  of  heart. 
Admitted  Nov.  9,  1912.     Discharged  Dec.  2,  1912. 

Good  record  of  admission,  and  of  physical  and  laboratory  examinations ;  all 
other  notes  by  nurse. 

Case  no.    Lobar  pneumonia. 
Admitted  Sept.  30,  1912.     Discharged  Oct.  11,  1912. 

Good   record  of   admission  and  physical   examination;   two  subsequent  clini- 
cal notes;  rest  of  record  by  nurse. 

Case  in.     Lobar  pneumonia. 
Admitted  June  26,  1912.     Discharged  (date  not  given). 

Good  history  except  omission  of  date  of  discharge. 


CLINICAL   RECORDS  355 

Case  112.     Lobar  pneumonia ;  general  septicaemia. 
Admitted  Sept.  23,  1912.     Died  Sept.  25,  1912. 

Good  record  of  admission  and  physical  examination;  all  other  notes  by 
nurse. 

Case  113.     Lobar  pneumonia. 
Admitted  Oct.  18,  1912.     Discharged  Oct.  30,   1912. 

Good  record  of  admission,  and  of  physical  and  laboratory  examinations ;  one 
clinical  note  Oct.  20;  remainder  of  record  (after  crisis)  by  nurse. 

Case  114.    Lobar  pneumonia. 
Admitted  Oct.  16,  1912.     Discharged  Nov.  7,  1912. 

Good  record  of  admission,  physical  examination,  and  laboratory  notes ;  re- 
mainder of  record  by  nurse. 

Case   115.    Lobar  pneumonia;   old  hemiplegia;  chronic  nephritis. 
Admitted  Nov.  7,  1912.    Died   Nov.   11,   1912. 

Good  record  of  admission,  and  of  physical  and  laboratory  examinations ;  all 
other  notes  by  nurse.    Last  note  Nov.   11 :    "Condition  unchanged." 

Case  116.    Lobar  pneumonia. 
Admitted  Feb.  8,  1913.    Died  Feb.  12,  1913. 

Good  record  of  admission  and  physical  examination;  one  subsequent  clinical 
note  (Feb.  loth)  indicates  that  condition  was  serious;  remainder  of  record  by 
nurse. 

Case  117.     Lobar  pneumonia. 
Admitted  Jan.  24,   1913.     Discharged  Jan.  31,  1913. 

Good  record  of  admission,  and  of  physical  and  laboratory  examinations;  re- 
mainder of  record  by  nurse. 

Case  118.     Lobar  pneumonia. 
Admitted  Dec.  22,  1912.     Discharged  Jan.  25,  1913. 

Nurse's  note  Dec.  22 :  "Examined  by  Dr.  " ;  no  record  of  this  ex- 
amination. First  recorded  physical  examination  is  dated  Jan.  2;  case  history 
otherwise  good. 

Case  119.     Subacute  rheumatic  fever. 
Admitted  Jan.  18, 1913.     Discharged  Jan.  23, 1913. 

Readmission  notes  refer  to  previous  record  (date  not  given)  for  statement 
of  patient's  condition;  remainder  of  record  by  nurse. 

Case  120.    Contusion  of  jaw. 
Admitted  Sept.  23,  1912.     Discharged  Oct.  i,  1912. 

Good  record  of  admission  and  physical  examination;  X-ray  record  shows 
fracture  of  both  bones  of  forearm;  remainder  of  record  by  nurse_.  Treatment 
recorded  is  for  fracture  of  bones  of  forearm.  Diagnosis  in  caption  not  con- 
sistent with  record. 

Case  121.     Necrosis  of  jaw. 
Admitted  Jan.  28,  1913.     Discharged  Jan.  30,  1913. 

Sufficient  record  of  admission  and  physical  examination;  remainder  of  record 
by  nurse.  Record  shows  no  basis  for  diagnosis  of  necrosis  except  swelling  and 
tenderness  of  jaw.  No  special  treatment  recorded  except  a  dose  of  oil.  Con- 
dition at  discharge  given  in  caption  only.     No  reason  given  for  discharge. 

Case  122.     Subacute  rheumatic  fever. 
Admitted  Jan.  19,  1913.     Discharged  Jan.  22,  1913. 

Complication  noted :  Fibroma  of  Breast.  Notes  of  admission  and  physical 
examination  describe  breast  lesion  only;  "bones,  joints  and  muscles  negative;" 
remainder  of  record  by  nurse.  The  only  indication  in  the  record  of  the  pres- 
ence of  rheumatic  fever  is  the  existence  of  fever  as  shown  in  the  temperature 
charts  and  the  following  nurse's  notes : 

"Jan.  19.  Pain  in  limbs  and  chest.  Jan.  20.  Pain  in  left  arm  and  shoulder, 
also  in  right  leg." 


356  HOSPITAL   COMMITTEE 

Case  123.     Abscess  of  kidney. 

Admitted  Aug.   12,  1912.     Discharged  Oct.  5,  1912. 

Sufficient  record  of  admission,  physical  examination,  and  operation ;  X-ray 
record;  remainder  of  record  by  nurse.  Result  stated  in  caption  only.  Post- 
operative course  can  only  be  inferred  from  nurse's  notes  of  "dressings  changed, 
etc." 

Case  124.     Dislocation  of  hip. 
Admitted  Jan.  7,  1913.     Discharged  Jan.  28,  1913. 

Copy  of  previous  history  attached  to  clinical  record  gives  an  account  of  con- 
vulsive seizures  and  of  previous  treatment  for  same  in  Flower  and  Bellevue 
hospitals. 

Discharge  note :  "Patient  discharged  to  home.  Advised  to  go  to  O.  P.  D. 
Diagnosis :  Dislocation  of  hip.  Post-operative  abdomen-hysteria."  Remainder 
of  record  by  nurse.  Beyond  the  nurse's  notes  of  "pain  in  side"  and  "pain  in 
hip,"  there  is  no  reference  to  any  condition  like  dislocation  of  the  hip  and  no 
record  of  such  dislocation  or  of  treatment  therefor  except  in  discharge  note 
quoted  above.     The  case  history  as  a  whole  indicates  some  nervous  disorder. 

Case  125.     Normal  puerperium. 
Admitted  Feb.  4,  1913.     Died  Feb.  6,  1913. 

Complications,  noted  in  caption  only :  "Endocarditis,  pulmonary  a;dema,  pul- 
monary tuberculosis." 

Admission  note:  "Admitted  post-partum — Transferred  from  School  of  M." 
All  other  notes  by  nurse  only. 

Case  126.     Amputation  of  stump. 
Admitted  Aug.  15,  1912.     Discharged  Oct.  i,  1912. 

Good  record  of  admission,  physical  examination,  and  operation;  remainder 
of  record  by  nurse.     Result  stated  only  in  caption. 

Case  127.     Ventral  hernia. 
Admitted  Sept.  16,  1912.     Discharged  Oct.  i,  1912. 

Good  record  of  admission,  physical  examination,  and  operation;  subsequent 
record  by  nurse.  Nurse's  note,  Sept.  27,  that  sutures  were  removed.  Otherwise, 
result  indicated  only  in  caption. 

Case  128.     Laceration  of  pelvic  floor. 
Admitted  Sept.  18,  1912.     Discharged  Oct.  6,  1912. 

Notes  of  admission  and  physical  examination  do  not  describe  local  con- 
dition ;  operation  note,  Sept.  25,  describes  curettage  of  uterus,  and  repair  of 
lacerated  cervix  and  lacerated  perineum;  subsequent  record  by  nurse.  Result 
stated  only  in  caption. 

Case  129.    Carcinoma  of  breast. 
Admitted  Aug.  15,  1912.     Discharged  Oct.  i,  1912. 

Good  record  of  admission,  physical  examination,  and  operation;  subsequent 
notes  by  nurse,  who  recorded  dressings  at  intervals  until  Sept.  28th.  Result  stated 
only  in  caption. 

Case  130.     Tubercle  of  knee  joint.     Complication :    Tubercle  of   vertebrje. 
Admitted   Sept.   10,   1912.     Discharged  Oct.   i,   1912. 

Good  record  of  admission  and  physical  examination ;  remainder  of  record 
by  nurse.  Nature  of  local  treatment  not  stated.  Condition  at  discharge  noted 
only  in  caption. 

Case  131.    Right  inguinal  hernia. 
Admitted  Sept.  11,  1912.     Discharged  Oct.  2,  1912. 

Good  record  of  admission,  physical  examination,  and  operation ;  remainder 
of  record  by  nurse.  Result  stated  only  in  caption.  No  statement  as  to  primary 
union  or  septic  infection. 

Case  132.     Carcinoma  of  uterus. 
Admitted  Sept.  9,  1912.     Discharged  Oct.  2,   1912. 

Good  record  of  admission,  physical  examination,  and  operation;  subsequent 
history  by  nurse.  Result  stated  only  in  caption.  Little  information  can  be  ob- 
tained as  to  post-operative  course. 


CLINICAL   RECORDS  357 

Case   133.     Erysipelas. 
Admitted  Jan.  28,  1913.    Discharged  Feb.  2,  1913. 

Admission  notes  scanty  and  scarcely  legible;  with  difficulty  it  was  gathered 
that  erysipelas  had  followed  a  mastoid  operation;  remainder  of  record  by  nurse. 
Condition  at  discharge  noted  only  in  caption. 

Case  134.    Lobar  pneumonia;  suppurative  pleurisy;  empyema;  septicaemia. 
Admitted  Nov.  27,  1912.     Died  Dec.  3,  1912. 

Good  record  of  admission,  physical  and  laboratory  examinations;  remainder 
of  record  by  nurse.  There  is  no  mention  in  the  body  of  the  report  of  the  com- 
plication noted  in  the  caption;  viz.,  empyema. 

Case  135.    Lobar  pneumonia. 
Died  Oct.  8,  1912. 

This  record  gives  nothing  except  the  anatomical  diagnosis  as  reported  by  the 
coroner.  No  data  of  any  kind  are  given  as  to  the  circumstances  of  admission 
or  death. 


AUTOPSY   FINDINGS   IN   BELLEVUE  HOSPITAL 
COMPARED  WITH   CLINICAL   DIAGNOSES 


THE  INVESTIGATION 

Previous  to  the  eighteenth  century  physicians  had  no  knowledge  of  the 
effect  of  diseases  on  the  organs  of  the  body.  Morgagni,  of  Italy,  in  the 
middle  of  the  eighteenth  century,  and  Bichat,  of  France,  in  the  latter  part 
of  the  same  century,  conceived  the  idea  that  the  organs  of  the  body  were 
affected  by  diseases  and  that  an  examination  of  the  organs  would  indicate 
the  character  of  the  disease  which  caused  death.  Their  work  paved  the 
way  for  the  brilliant  work  of  Rokitansky,  of  Vienna,  who  worked  in  the 
middle  of  the  nineteenth  century.  Virchow,  of  Germany,  and  other  patho- 
logical anatomists,  following  in  the  footsteps  of  these  earlier  experiment- 
ers, have  shown  clearly  that  certain  diseases  have  definite  effects  upon  the 
internal  organs,  and  that  the  degree  of  these  effects  may  be  determined 
previous  to  death  by  various  methods.  These  methods  are  now  familiar 
to  all  good  diagnosticians.  Very  rapid  progress  has  been  made  in  the 
art  of  diagnosing  because  of  the  facts  brought  out  by  autopsies,  but  advance 
along  these  Hnes  has  been  made  much  more  rapidly  in  Europe  than  in 
America,  because  the  hospitals  in  Europe  are  empowered  to  perform 
autopsies  on  nearly  all  bodies.  In  1912  the  University  College  Hospital, 
in  London,  performed  autopsies  in  84  per  cent,  of  the  deaths.  Most  of  the 
hospitals  in  Germany  perform  autopsies  in  over  90  per  cent,  of  deaths,  and 
the  Allgemeines  Krankenhaus,  in  Vienna,  performed  autopsies  in  as  high 
a  percentage  of  deaths  as  99.9  per  cent. 

Bellevue  Hospital,  on  the  other  hand,  performs  autopsies  in  only  about 
10  per  cent,  of  the  deaths.  Bellevue  is  not,  however,  an  exception  to  hos- 
pitals generally  in  the  United  States.  Boston  City  Hospital  performs  in 
about  9  per  cent,  and  Philadelphia  General  Hospital  in  10  per  cent,  of 
deaths.  A  few  hospitals  in  the  United  States  show  a  higher  percentage. 
For  instance,  Johns  Hopkins  Hospital  has  performed  autopsies  in  62.8  per 
cent,  of  deaths. 

So  long  as  it  is  impossible  to  perform  a  larger  percentage  of  autopsies 
medical  knowledge  in  the  United  States  will  lag  behind  that  of  Europe, 
and  advancement  will  necessarily  be  slow.  In  this  country  very  satisfac- 
tory progress  is  being  made  in  surgical  knowledge  and  methods,  and  in  the 
study  of  bacteriological  diseases,  but  advance  in  knowledge  of  chronic  dis- 
eases and  diseases  relating  to  a  disturbed  metabolism  is  slow.  Progress 
along  these  lines  will  be  greatly  retarded  by  lack  of  opportunity  to  study 
effects  upon  organs  and  tissues  of  various  treatments  which  may  be  admin- 
istered. 

Bellevue  Hospital  has  built  and  equipped  the  finest  pathological  labora- 
tory building  in  the  United  States,  and  probably  the  best  in  existence.  It 
is  provided  with  every  modern  facility  for  performing  autopsies  and  fol- 
lowing up  such  autopsies  by  experimental  work  upon  tissues,  but  although 
the  Hospital  has  provided  itself  with  this  exceptionally  well-designed  and 
thoroughly  equipped  building  it  is  practically  unable  to  use  it,  because  of  its 
inability  to  secure  permission  to  perform  autopsies. 

Autopsies  may  be  performed  on  any  body,  provided  relatives  of  the 
deceased  consent  to  an  autopsy.  Previous  to  April  15,  1910,  Bellevue  was 
enabled  to  perform  autopsies  on  all  bodies  not  claimed  by  relatives  or 

361 


362  HOSPITAL   COMMITTEE 

friends  within  a  period  of  48  Iiours  after  death.  These  bodies  were 
classed  as  "overdue."  It  is  difficult  to  secure  consents  of  relatives, 
because  of  an  inherent  prejudice  against  autopsies,  and  a  fear  that  the 
body  may  be,  in  some  way,  mutilated.  It  has  been  possible,  however,  to 
secure  a  certain  proportion  of  such  consents,  and  beiow  is  given  the  total 
number  of  autopsies  performed  in  Bellevue  during  the  last  six  years,  show- 
ing those  performed  by  consent  and  those  performed  on  the  unclaimed 
bodies : 

Date                                                             By  Consent  Overdue  Total 

1907 143  263  406 

1908 134  208  342 

1909 173  266  439 

1910 163  109  272 

1911 216  102  31S 

1912 423  12  435 

It  will  be  noticed  that  in  1907  143  autopsies  were  performed  by  consent 
and  263  on  "overdue"  bodies,  whereas  in  1912  the  number  of  bodies  by 
consent  had  risen  to  423  and  the  "overdue"  bodies  had  been  reduced  to 
12.  The  reduction  in  the  number  of  autopsies  performed  on  overdue  bod- 
ies was  due  to  the  order  issued  by  the  Commissioner  of  Charities  on  the 
date  stated  above  (April  15,  1910).    This  order,  in  part,  was  as  follows: 

That  on  and  after  this  date  no  autopsies  on  the  bodies  of  the  unclaimed  dead 
will  be  permitted  in  the  City  Morgue  without  the  consent  of  the  Commissioner  of 
Public  Charities  or  his  duly  authorized  representative,  in  writing,  excepting  such 
autopsy  or  autopsies  as  are  performed  by  the  direction  of  a  coroner  or  by  authority 
of  the  District  Attorney  of  the  County  of  New  York,  or  such  autopsies  as  are 
performed  on  bodies  assigned  to  medical  colleges  in  accordance  with  law. 

Autopsies  on  bodies  assigned  to  medical  colleges  are  to  be  permitted  only  by 
written  authority  of  said  medical  college  or  colleges. 

The  bodies  of  the  unclaimed  dead,  after  all  reasonable  steps  have  been  taken 
to  locate  friends  or  relatives,  shall,  after  the  expiration  of  48  hours,  be  assigned 
in  proportion  to  the  number  of  matriculant  students  to  the  medical  colleges  of 
the  City  of  New  York  authorized  by  law  to  confer  the  degree  of  Doctor  of  Medi- 
cine, and  the  Morgue  Keeper  or  his  Assistant  must  obtain  a  receipt  for  each  body 
delivered     *     *     *     * 

It  will  be  noticed  that  the  Commissioner  of  Charities  issued  an  order 
that  all  unclaimed  bodies  should  be  delivered  to  the  medical  colleges,  and 
that  no  autopsies  could  be  performed  upon  such  bodies  before  delivery 
except  on  the  written  consent  of  such  colleges.  The  medical  colleges  de- 
sire these  bodies  for  the  teaching  of  anatomy.  They  perform  no  autopsies 
upon  them,  and  no  knowledge  is  gained  by  their  use  except  knowledge  of 
the  structure  of  the  body.  According  to  the  records  of  the  Health  De- 
partment, during  1912  these  unclaimed  bodies  were  distributed  to  the 
medical  colleges  as  follows : 

Bellevue  Medical  College 237 

Eclectic  Medical  College 39 

Flower  Hospital 6 

Woman's  College 14 

Fordham  Medical  College 65 

Columbia  Medical  College 130 

Cornell  Medical  College 98 

Homeopathic  Medical  College 66 

Physicians  and  Surgeons 6 

Total 661 


AUTOPSY  FINDINGS  363 

The  basis  on  which  the  Commissioner  issued  his  order  of  April  15, 
1910,  was  a  report  by  a  special  committee  appointed  by  him  on  January 
29th  of  the  same  year,  "  *  *  *  *  to  consider  the  question  of  the  sup- 
ply of  anatomical  material  and  its  distribution  to  the  incorporated  medical 
teaching  institutions  of  New  York  City  *  *  *  * ."  The  committee 
consisted  of  five  members :  Dr.  George  S.  Huntington,  Dr.  Royal  S.  Cope- 
land,  Dr.  John  J.  McGrath,  Dr.  Charles  Norris,  and  Dr.  Horst  Oertel. 

The  three  first-mentioned  members  of  the  committee  presented  a  ma- 
jority report  on  March  2,  and  the  last  two  named  members  presented  a 
minority  report  on  about  the  same  date.  The  majority  report  interpreted 
Sections  316  and  317  of  the  Public  Health  Laws  as  making  it  mandatory 
upon  the  Commissioner  of  Charities  to  transfer  the  bodies  of  all  unclaimed 
dead  to  the  medical  schools  for  purposes  of  medical  study  and  instruc- 
tion. Although  the  report  interpreted  the  law  to  refer  only  to  under- 
graduate medical  schools,  it  recommended  that  a  broad  interpretation  be 
placed  upon  the  law  and  that  post-graduate  schools  also  be  permitted  to 
receive  such  bodies.  In  the  report  was  incorporated  a  list  of  medical 
schools  which  it  recommended  should  be  adopted  as  the  official  list  to 
which  bodies  should  be  sent,  and  in  this  list  were  included  two  post- 
graduate medical  schools. 

The  minority  report  held  that  the  law  could  not  be  interpreted  to  apply 
to  post-graduate  medical  schools,  and  that  the  Commissioner  was  not  em- 
powered to  assign  bodies  to  such  schools.  It  held,  moreover,  that  there 
was  nothing  in  the  law  to  prohibit  an  accredited  professor  of  any  one 
of  the  medical  schools  performing  autopsies  upon  unclaimed  bodies.  It 
had  been  the  custom  in  Bellevue  to  assign  certain  bodies  to  professors  of 
the  medical  schools,  thereby  securing  autopsies  upon  unclaimed  bodies,  but, 
according  to  the  majority  report,  such  autopsies  should  not  be  performed. 
It  was  held  by  the  majority  report  that,  had  the  medical  colleges  received 
all  of  the  unclaimed  bodies  to  which  they  were  entitled  during  the  previous 
year,  there  would  have  been  1,040  bodies  assigned,  and  they  further  stated: 
"This  amount  of  material  would  not  have  fulfilled  adequately  the  modern 
requirements  of  medical  education  *  *  *  * ."  The  minority  report 
held  that  there  were  about  1,367  undergraduate  medical  students  in  New 
York  City,  and  that  but  half  of  this  number  required  anatomical  material; 
and  that  i  body  was  sufficient  for  2  students,  which  would  require  but  342 
bodies,  with  66  additional  bodies  assigned  for  anatomical  work  of  a  special 
kind. 

The  general  contention  of  the  majority  report  was  that  the  law  provided 
that  all  unclaimed  bodies  should  be  assigned  to  the  medical  schools,  and 
that  the  schools  needed  all  such  bodies  for  anatomical  purposes.  The  con- 
tention of  the  minority  was  that,  although  the  law  provided  that  the  medi- 
cal schools  should  receive  the  unclaimed  bodies,  there  was  no  provision  in 
the  law  that  autopsies  might  not  be  performed  previous  to  the  delivery  of 
such  bodies;  and  that  the  schools  needed  but  a  portion  of  the  unclaimed 
bodies  of  New  York  City. 

To  secure  some  opinions  with  regard  to  the  amount  of  anatomical  ma- 
terial needed  by  medical  colleges  a  communication  was  addressed  to  several 
instructors  in  anatomy,  in  which  the  following  questions  were  asked : 

I.    What,   in  your   judgment,   is   an   ample   provision   of   anatomical   material 
for  each  student  during  his  first  and  second  years  in  medical  college? 


364  HOSPITAL   COMMITTEE 

2.  What   is  the  average  number  of   subjects    now  supplied  to   each   of   your 
students  in  Medical  School? 

3.  To  what  extent,  in  your  opinion,  are  subjects  upon  which  autopsies  have 
been  made,  available,  if  at  all,  for  purposes  of  dissection? 

Replies  received  in  answer  to  this  communication  were  as  follows : 

Dr.   George  A.   Piersol,  University  of  Pennsylvania 

1.  The  opportunity  to  dissect  two  entire  bodies  during  his  first  and  second 
years  is,  in  my  opinion,  an  "ample  provision"   for  each  student. 

2.  The  student  is  required  to  dissect  one  entire  body  in  the  Medical  School 
of  the  University  of  Pennsylvania.  Many  students,  however,  dissect  additional 
parts. 

Dr.  F.  p.  Mall,  Johns  Hopkins  Medical  School 

An  ample  supply  of  anatomical  material  should  allow  one  whole  body  to 
each  first  year  student. 

1.  On  an  average  one-half  of  this  should  be  used  for  the  first  year,  and  one- 
half  for  the  second  year  of  the  medical  course. 

2.  Our  supply  is  greater  than  this,  so  we  select  the  best  subjects,  and  send 
all  the  bodies  that  have  been  autopsied  to  the  Potter's  Field  or  have  skeletons 
made  of  them. 

3.  When  it  comes  to  the  serious  study  of  an  anatomy  an  autopsied  subject 
is  of  very  little  value. 

4.  The  bulk  of  the  study  should  be  devoted  to  the  head,  neck,  and  trunk, 
which,  of  course,  includes  the  viscera.  Since  a  number  of  whole  subjects  have  dis- 
eased viscera,  it  is  necessary  to  allow  the  whole  subject  to  each  first  year  student 

Dr.  R.  H.  Whitehead,  University  of  Virginia 

1.  One  lateral  half  of  a  body  per  student  for  dissecting  is,  in  my  opinion, 
the  smallest  amount  allowable.  In  addition  to  the  material  for  dissection  by 
individual  students  other  bodies  are  needed  for  making  stock  preparations,  etc. 

2.  One  body  to  each  pair  of  students. 

3.  The  utilization  of  subjects  which  have  been  submitted  to  autopsy  cannot 
be  made  very  effective  here,  because  we  assign  an  entire  body  to  a  pair  of  students. 
Where,  however,  the  body  for  dissection  is  divided  into  a  large  number  of  "parts," 
some  use  can  be  made  of  such  material  (upper  and  lower  extremities).  At  best, 
however,  the  use  of  such  material  is  apt  to  be  unsatisfactory,  owing  to  the  great 
trouble  involved  in  making  satisfactory  embalming  arterial  injections,  etc. 

It  will  be  noticed  by  reviewing  the  above  letters  that  none  of  the  anat- 
omists holds  that  a  student  needs  more  than  i  body  for  anatomical  pur- 
poses during  his  entire  course,  or  half  of  such  body  for  each  of  his  first 
two  years.  Dr.  Whitehead,  of  Virginia,  states  that,  in  his  opinion,  i 
lateral  half  for  each  student  for  the  whole  course  is  sufficient.  According 
to  the  basis  indicated  by  these  anatomists,  the  number  of  bodies  required 
by  the  undergraduate  medical  students  of  New  York  City  would  be  about 
342.    During  1912  these  colleges  actually  received  661  bodies. 

The  majority  report  above  referred  to  contended  that  the  hospitals 
should  be  able  to  secure  all  the  material  necessary  from  consent  autopsies. 
The  minority  members  of  the  Committee  held  that  consent  autopsies  must 
be  performed  at  uncertain  and  inconvenient  hours,  many  times  with  great 
haste,  to  meet  the  convenience  of  the  undertaker  or  friends;  and  that  for 
this  reason  it  was  exceedingly  difficult  to  use  such  autopsies  for  the  purpose 
of  instruction.    These  members  of  the  committee  held  that  autopsies  per- 


AUTOPSY   FINDINGS  365 

formed  upon  unclaimed  bodies  were  the  only  proper  basis  of  instruction,  in- 
asmuch as  the  autopsies  could  be  held  at  stated  and  determined  hours,  and 
with  such  leisure  as  to  afford  ample  opportunity  for  demonstration  and  in- 
struction. 

It  seems  that  those  signing  the  majority,  and  those  signing  the  minority, 
reports  are  justified  in  part  in  their  different  contentions.  The  law  seems 
clearly  to  assign  the  unclaimed  bodies  to  medical  schools,  but,  on  the  other 
hand,  the  law  does  not  seem  to  forbid  the  performing  of  autopsies  previous 
to  the  delivery  of  such  bodies.  Also,  those  signing  the  majority  report 
seem  to  claim  for  anatomical  purposes  many  more  bodies  than  they  need 
for  proper  instruction  of  students,  which  surplus  bodies  might  readily  have 
been  autopsied  before  delivery  to  the  colleges.  In  this  connection  reference 
is  made  to  the  large  percentage  of  autopsies  made  in  the  hospitals  of  Eu- 
rope and  the  marked  advance  in  medical  knowledge  due  in  a  measure 
thereto. 

To  throw  further  light  upon  the  need  for  autopsies  as  a  method  of 
verifying  the  ante-mortem  diagnoses  an  examination  was  made  of  the 
autopsy  findings  in  Bellevue.  The  post-mortem  findings  of  the  autopsies 
performed  during  the  year  1912  were  compared  with  the  ante-mortem  or 
clinical  diagnoses  made  by  the  physicians  in  each  case.  This  comparison 
was  made  on  behalf  of  the  Committee  by  Dr.  Horst  Oertel,  formerly  Chief 
Pathologist  of  the  Russell  Sage  Pathological  Institute,  located  at  City 
Hospital.  Dr.  Oertel  compared  the  findings  recorded  in  connection  with 
each  autopsy  with  the  medical  record  and  diagnosis  made  in  the  hospital 
previous  to  the  death  of  such  subject,  and  has  placed  his  findings  in  five 
classes  or  divisions,  as  follows : 


Class 

I.     Clinical  Diagnoses  confirmed 87      22.4% 

II.     Clinical  diagnoses  correct  but  autopsies  disclosed  additional  impor- 
tant lesions 116      29.9% 

III.  Clinical  diagnoses  partly  correct  but  other  important  lesions  that 

had  contributed  to  the  diagnosed  lesions  were  found 54      13.9% 

IV.  Clinical  diagnoses  not  confirmed 107      27 . 6% 

V.     No  clinical  diagnoses  in  death  records 24        6.2% 


388     100.0% 


To  give  a  clearer  understanding  of  the  type  of  cases  included  within 
each  class  the  following  cases  are  given  as  illustrative  of  the  above  classes : 

Class  I.     Clinical  diagnoses  confirmed. 
Case  No.  3212. 
Clinical   diagnosis :     Peritonitis.     Acute  general   nephritis.     Acute  puerperium. 
Postmortem  findings :    Septicemia.     General   suppurative  peritonitis.     Suppura- 
tive metritis   with  abscess.     Acute  necrotic  vaginitis.     Acute  splenic  tumor. 
Acute  parenchymatous  hepatitis  and  nephritis   (marked).     Subacute  adhesive 
pleuritis  with  effusion  (double).     Acute  congestion  of  lungs. 

Class   II.     Clinical   diagnoses   correct  but  autopsies   disclosed   additional  important 
lesions. 
Case  No.  3080. 
Clinical  diagnosis:  Otitis  media   (right). 

Postmortem  findings :    Broncho-pneumonia  in  apex  of  left  lung.     Acute  paren- 
chymatous nephritis.    Otitis  media  (right). 


366  HOSPITAL   COMMITTEE 

Class  III.     Clinical  diagnoses  partly  correct  but  other  important  lesions  that  had 
contributed  to  the  main  diagnosed  lesions  were  found. 
Case  No.  3072. 
Clinical  diagnosis :    Broncho-pneumonia. 

Postmortem  findings :  Acute  miliary  tuberculosis.  Tubercular  broncho-pneu- 
monia (left  lower  lobe). 

Class  IV.     Clinical  diagnoses  not  confirmed. 
Case   No.  3132. 

Clinical  diagnosis :     Oironic  interstitial  nephritis. 
Postmortem     findings :       Glanders.       Acute     splenic    tumor.       Chronic    fibrous 
pleurisy.     Hypostatic  congestion,  left  lung.     Degeneration  of  liver,  myocar- 
dium and  kidneys. 

Case  No.  3047. 
Clinical  diagnosis :     Carcinoma  of  gall  bladder. 

Postmortem  findings:  Chronic  aortitis.  Serofibrinous  pleurisy  (left).  Acute 
verrucous  aortic  valvulitis. 

Class  V.     No  clinical  diagnoses  in  death  records. 
Case  No.  3455. 
Clinical  diagnosis :    None. 

Postmortem  findings :  Dilatation  and  hypertrophy  of  right  and  left  ventricles. 
Chronic  myocarditis.  Chronic  oedema  of  lungs  with  slight  pial  oedema. 
Chronic  adhesive  pleuritis  (right).  Chronic  hypostatic  congestion  of  lungs. 
Chronic  interstitial  splenitis. 

It  will  be  observed  that  the  above  findings  by  Dr.  Oertel  show  that  the 
clinical  diagnoses  were  confirmed  in  52.3  per  cent,  of  the  cases,  and  that 
they  were  not  confirmed  in  47.7  per  cent,  of  the  cases. 

Some  question  might  be  raised  as  to  the  propriety  of  including  Class  III 
among  the  diagnoses  not  confirmed,  but  inasmuch  as  the  chief  cause  of 
death  was  not  located  or  diagnosed  it  would  seem  proper  to  include  these 
cases  among  those  not  confirmed. 

During  1912  there  were  3,170  deaths  in  Bellevue.  If  the  same  percent- 
age of  wrong  diagnoses  maintained  in  connection  with  the  total  number  of 
deaths  as  in  connection  with  those  that  were  autopsied,  there  would  have 
been  1,512  deaths  in  Bellevue  from  causes  not  fully  known  or  rightly  diag- 
nosed. It  is,  of  course,  impossible  to  rightly  diagnose  in  all  cases.  Outward 
manifestations  or  symptoms  are  often  so  obscure  and  undefined  that  the  real 
cause  of  ailment  is  problematical.  This  may  be  illustrated  by  the  findings  of 
Dr.  Richard  Cabot,  who,  in  "A  Study  of  Mistaken  Diagnoses,"  lists  1,761 
cases  wherein  he  compared  the  autopsy  findings  with  the  clinical  diagnoses 
and  data.  In  his  presentation  of  the  matter  he  divided  the  causes  of  death 
into  about  29  classes  and  gave  the  percentages  of  correct  and  mistaken  diag- 
noses in  each  class.  The  average  percentage  of  correctness  of  the  diagnoses 
in  all  of  these  cases,  taken  as  a  whole,  was  40.3  per  cent.  He  makes  the 
following  explanation  of  his  methods  in  making  comparisons : 

My  comparisons,  then,  have  been  far  from  literal.  In  each  case  I  have 
gone  behind  the  recorded  diagnosis  and  endeavored  to  reason  out  what  diagnosis 
was  justified  by  the  facts  as  known  during  life  *  *  *  *  My  comparisons,  then, 
have  been  made  between  the  diagnosis  warranted  by  the  recorded  clinical  data 
and  the  autopsy  protocols. 

It  appears  from  his  statement  that  Dr.  Cabot  has  not  merelycompared 
the  autopsy  protocols  with  the  diagnosis  appearing  upon  the  clinical  rec- 
ords, but  has  also  taken  into  consideration  the  clinical  data  which,  when 
interpreted,  might  lead  to  a  dififerent  diagnosis  from  that  recorded.     In 


AUTOPSY   FINDINGS  367 

Other  words,  by  interpretation  he  has  reduced  the  element  of  error  as  much 
as  possible.  Had  he  adopted  the  method  pursued  by  Dr.  Oertel,  wherein 
he  compared  the  autopsy  findings  with  the  recorded  clinical  diagnoses,  his 
percentage  of  errors  would  probably  have  been  somewhat  greater.  The 
percentages  of  error  recorded  by  Dr.  Cabot,  then,  may  be  considered  not 
far  different  from  those  found  in  Bellevue. 

The  conclusions  to  be  drawn  from  the  large  percentage  of  errors  in 
clinical  diagnoses  revealed  in  the  records  of  Bellevue  are  not  that  the  findings 
of  the  attending  physicians  of  Bellevue  are  carelessly  made  and  recorded, 
but  rather  that  too  great  reliance  is  placed  upon  inexperienced  house  physi- 
cians and  internes,  and  also  that  the  current  knowledge  necessary  to  make 
clinical  diagnoses  which  shall  approach  accuracy  is  insufficient.  Not,  of 
course,  insufficient  as  applied  merely  to  the  attending  physicians  of  Belle- 
vue, since  it  may  be  supposed  that  they  represent  the  best  current  medical 
knowledge.  The  conclusion  may  be  legitimately  drawn  that  medical  knowl- 
edge is  not  sufficiently  advanced  to  enable  physicians  to  diagnose  with  great 
degree  of  accuracy. 

Since  autopsy  findings  are  the  chief  means  of  correcting  the  mistakes 
of  clinical  diagnoses  and  the  enlargement  of  knowledge  of  the  causes  and 
progress  of  diseases,  it  would  seem  of  the  utmost  importance  that  as  many 
autopsies  be  performed  as  possible,  and  the  necessity  for  such  autopsies 
would  seem  to  be  of  much  greater  importance  than  the  use  of  bodies  for 
anatomical  dissection. 

It  is  exceedingly  difficult  to  secure  consents  for  autopsies  from  rela- 
tives and  friends,  and  there  is  little  hope  of  securing  a  much  larger  percent- 
age of  consents  than  at  present  except  through  the  gradual  education  of  the 
public  to  the  value  of,  and  necessity  for,  autopsies.  It  seems  obvious, 
therefore,  that  efforts  should  be  made  to  secure  the  privilege  of  autopsying 
as  large  a  proportion  as  possible  of  the  unclaimed  dead.  If  the  Commis- 
sioner of  Charities  has  rightly  interpreted  the  existing  law  unclaimed 
bodies  cannot  be  autopsied,  but  must  be  distributed  intact  to  medical  col- 
leges. Inasmuch  as  it  seems  highly  probable  that  the  medical  colleges  need 
but  a  small  proportion  of  the  unclaimed  bodies  for  anatomical  purposes,  it 
would  seem  highly  important  that  the  existing  law  regulating  the  disposal 
of  such  bodies  should  be  so  amended  as  to  permit  accredited  hospitals  to 
perform  autopsies  upon  the  unclaimed  bodies,  setting  aside  only  such  a  pro- 
portion for  the  use  of  the  medical  colleges  as  may  be  actually  necessary  for 
their  rightful  purposes. 

The  existing  law  provides  that  only  the  husband,  wife,  or  next  of  kin 
of  the  deceased  may  authorize  an  autopsy,  except  in  such  cases  as  fall 
under  the  control  of  coroners,  or  some  officer  of  the  courts.  No  friend  is 
authorized  to  permit  an  autopsy,  and,  as  before  stated,  according  to  the 
present  interpretation  of  the  law  unclaimed  bodies  must  be  distributed  to 
medical  colleges  without  having  been  autopsied. 

For  the  advancement  of  medical  knowledge  and  the  protection  of  the 
living  it  would  seem  highly  advisable  to  so  amend  the  existing  law  as  to 
provide  for  autopsying  the  largest  possible  proportion  of  bodies.  To  accom- 
plish this  purpose  it  is  suggested  that  the  existing  law  be  amended  in  the 
following  particulars : 

I.  That  accredited  hospitals  be  permitted  to  perform  autopsies  in  all 
cases,  except  those  where  they  are  expressly  forbidden  to  perform  such 


368  HOSPITAL  COMMITTEE 

autopsy  by  the  wife,  or  husband,  or  next  of  kin    within  48  hours  after 
death. 

2.  That  autopsies  be  performed  upon  the  bodies  of  all  persons  dying  in 
public  institutions,  whether  hospitals,  prisons,  reformatories,  almshouses, 
asylums,  or  other  institutions  of  a  public  character,  unclaimed  by  hus- 
band, wife,  or  next  of  kin  within  48  hours  after  death,  or  unless  the  de- 
ceased, while  in  the  institution,  has  signed  a  request  that  no  autopsy  be 
performed ;  except  such  proportion  of  these  bodies  as  may  be  necessary  for 
the  legitimate  needs  of  medical  colleges  for  teaching  purposes. 


3.  DISTRIBUTION  OF  WARD   SPACE  IN 
BELLEVUE  HOSPITAL 


THE  INVESTIGATION 

BY 

Dr.  L.  L.  Williams 

A  daily  census  of  the  wards  in  the  Surgical,  Gynecological,  Genito-urin- 
ary,  and  (adult)   Medical  Services  for  the  3  months  ended  December  31, 
1912,  is  the  basis  of  the  subjoined  tables.    An  examination  of  these  tables  * 
furnishes  the  following  data: 

In  the  male  wards  of  the  Medical  Service,  with  a  total  capacity  of  220 
beds,  the  average  percentage  of  vacant  beds  during  this  quarter  was  25.1 ;  in 
other  words,  these  wards,  in  the  aggregate,  were  three- fourths  full  as  a  rule ; 
56  of  the  220  beds  having  been  vacant. 

In  the  female  wards  of  the  Medical  Service,  with  a  total  capacity  of  103 
beds,  the  average  percentage  of  vacant  beds  was  20.3;  17  beds,  or  one-sixth 
of  the  total  number,  having  been  vacant  as  a  rule. 

In  the  Genito-urinary  Service,  with  a  total  capacity  of  79  beds,  the  aver- 
age percentage  of  vacant  beds  was  27.8;  22  beds,  more  than  a  fourth,  hav- 
ing been  vacant  as  a  rule. 

The  male  wards  of  the  Surgical  Service,  with  a  total  capacity  of  184 
beds,  showed  4.1  per  cent,  average  vacancies;  7  beds  only  having  been  va- 
cant, as  a  general  rule,  in  the  entire  service. 

In  the  female  wards  of  the  Surgical  Service,  with  a  total  capacity  of  71 
beds,  the  vacancies  averaged  14.4  per  cent.;  10  beds  having  usually  been 
vacant. 

In  the  children's  wards  of  the  Surgical  Service,  with  a  total  capacity  of 
52  beds,  instead  of  vacancies  there  was  found  to  have  been  for  the  quarter 
an  average  of  10.4  per  cent,  additional  beds  in  the  wards.  During  the  month 
of  November  one  of  these  wards  (ward  16)  showed  an  average  overcrowd- 
ing of  47.1  per  cent,  above  its  normal  capacity. 

To  summarize : 

The  Surgical  Service,  in  a  total  of  255  beds,  had,  on  an  average,  only 
12  surplus  beds  to  provide  for  fluctuations  in  admissions  and  discharges. 

The  Medical  Service,  in  a  total  of  323  beds,  had,  on  an  average,  yy  sur- 
plus beds  to  provide  for  fluctuations. 

The  Genito-urinary  Service,  in  a  total  of  79  beds,  had,  on  an  average, 
21  surplus  beds  to  provide  for  fluctuations. 

During  October  the  male  medical  wards  were  not  full  at  any  time. 
During  November  the  male  medical  wards  of  the  Third  Division  were  full 
on  2  occasions,  the  other  divisions  showing  vacancies.  During  December 
the  male  medical  wards  in  the  Third  Division  were  full  on  2  occasions,  the 
others  showing  vacancies. 

In  the  female  Medical  Service  the  wards  during  October  were  full  8 
times  in  the  Second  Division;  15  times  in  the  Third  Division;  and  2  times 
in  the  Fourth  Division.  During  November  they  were  full  on  2  occasions 
in  the  Second  Division;  6  times  in  the  Third  Division;  and  5  times  in  the 

371 


372  HOSPITAL   COMMITTEE 

Fourth  Division.  During  December  they  were  full  on  3  occasions  in  the 
Third  Division. 

In  the  Surgical  Service  the  wards  were  full  or  showed  additional  beds 
on  many  days  during  the  period  covered  by  the  inquiry,  the  maximum 
having  been  reached  in  the  children's  ward  of  the  Second  Division,  which 
was  full  or  overcrowded  every  day  during  October  and  November. 

By  reference  to  Tables  I  to  VI  it  will  be  seen  that  these  figures  corre- 
spond closely  with  the  average  percentage  of  vacancies  in  the  various  divi- 
sions. With  a  view  to  establishing  approximately  a  normal  average  per- 
centage of  vacant  beds  in  a  ward  or  group  of  wards,  that  is,  an  average 
of  vacancies  which  would  indicate  that  the  ward  or  wards  were  working 
at  approximately  full  capacity  but  without  overcrowding.  Table  XII  was 
constructed.  It  was  found  that  wards  showing  average  vacancies  of  10 
per  cent,  and  under  were  full  or  showed  additional  beds  40  days  in  lOO 
days,  or  40  per  cent,  of  the  time.  These  figures  fell  to  15  per  cent.,  or 
15  days  in  100,  in  wards  showing  more  than  10  per  cent,  and  not  more  than 
15  per  cent,  of  vacancies. 

In  following  this  line  of  inquiry  further  (including  the  above-mentioned 
wards  for  a  period  of  3  months,  and  the  wards  of  the  Genito-urinary  Serv- 
ice for  I  year)  it  was  found  that  wards  showing  average  vacancies  of  from 
12  per  cent,  to  15  per  cent,  were  full  14  days  in  100,  and  that  there  never 
were  more  than  i  or  2  beds  in  excess  of  the  normal  capacity. 

It  may  be  fairly  assumed  that  an  average  of  12  per  cent,  vacancies  is 
approximately  normal;  that  is,  that  wards  showing  such  an  average  of 
vacancies  would  never  be  objectionably  crowded,  and  that  wards  showing 
an  average  of  more  than  15  per  cent,  vacancies  are  not  running  at  their 
full  capacity,  the  ward  space  not  being  utilized  to  the  best  advantage. 

These  data  clearly  show  that,  while  the  wards  of  the  Surgical  Service 
were  congested  during  this  period,  the  wards  of  the  Medical  and  Genito- 
urinary Services  contained  numerous  vacant  beds.  The  ward  space  as  be- 
tween these  services  therefore  is  not  equitably  divided,  and  the  figures  sug- 
gest the  propriety  of  a  rearrangement  of  the  wards  with  a  view  to  prevent- 
ing a  chronic  congestion  in  the  Surgical  Service.  The  latter  evidently  needs 
more  room. 

There  is  not  only  great  variation  in  the  relative  amount  of  ward  space 
allotted  to  the  several  services,  so  that  one  is  overcrowded  while  another 
has  abundant  space,  but  there  are  local  congestions  in  a  service.  A  few 
instances  will  suffice  to  show  this.  Reference  to  Tables  IX,  X,  and  XI 
will  show  this  local  congestion  in  certain  wards  in  the  Surgical  Service,  one 
division  requiring  additional  beds,  while  other  divisions  had  vacant  beds. 

The  conditions  presented,  therefore,  were: 

1.  Certain  services  running  at  practically  the  full  capacity  of  the 
wards,  with  periods  of  overcrowding,  while  in  other  services  the  wards 
were  only  partly  full. 

2.  In  a  service  overcrowding  was  shown  in  one  division,  while  similar 
wards  in  other  divisions  were  partly  vacant. 

It  can  scarcely  be  contended  that  this  was  an  economical  allotment  of 
ward  space.  At  the  same  time,  this  failure  to  utilize  space  to  the  best 
advantage  was  not  traceable  to  dereliction  on  the  part  of  any  one  indi- 
vidual, but  rather  to  the  peculiarities  of  the  system  of  administration  of 
the  ward  service. 


DISTRIBUTION   OF    WARD   SPACE 


i7Z 


With  the  exception  of  a  few  independent  services — Alcoholic,  Maternity, 
etc. — the  various  services  are  divided  more  or  less  evenly  among  the 
four  divisions.  Each  of  these  divisions  possesses  its  own  separate  visiting 
staff  and  house  staff,  and  is,  in  effect,  a  separate  hospital  organization  in  so 
far  as  its  medical  administration  is  concerned.  Except  at  night,  when  ad- 
missions are  few,  patients  are  admitted  in  rotation  to  these  divisions  with- 
out regard  to  whether  or  not  the  wards  of  one  division  are  more  crowded 
than  those  of  another.  In  addition,  visiting  physicians  and  surgeons  are 
permitted  to  send  to  their  respective  divisions  so-called  "private  patients." 
These  are  usually  patients  who  have  been  under  treatment  by  them  in  one 
or  other  of  the  public  dispensaries. 

There  is  no  transfer  of  patients  from  the  wards  of  one  division  to  those 
of  another  division,  except  under  certain  rare  conditions.  Once  admitted 
to  a  division  a  patient  stays  in  that  division  until  his  discharge  from  the 
Hospital.  Each  division  is  sufficient  to  itself,  using  the  material  in  its  own 
wards  for  teaching  purposes,  and  neither  permitting  the  visiting  staffs  of 
other  divisions  to  use  the  material  in  its  wards  nor  itself  infringing  upon 
the  preserves  of  the  others.  Under  this  rigid  system,  with  each  division 
jealously  guarding  its  rights,  and  taking  into  consideration  the  inevitable 
fluctuation  in  the  length  of  stay  of  patients  in  the  wards,  the  occurrence  of 
local  overcrowding  is  easily  explained.  And  such  conditions  are  bound  to 
continue  as  long  as  power  is  vested  in  no  one  of  the  officers  of  the  Hospital 
to  forbid  admissions  to  crowded  wards  when  space  is  available  elsewhere, 
and  to  compel  the  transfer  of  patients  from  congested  wards  to  others  with 
vacant  beds. 

Several  solutions  suggest  themselves.  Partial  relief  may  be  obtained 
by  authorizing  some  officer  of  the  Hospital,  preferably  the  Superintendent, 
who  is  not  affiliated  with  any  of  the  divisions,  to  exercise  control  over  the 
admission  and  distribution  of  patients,  admitting  them  to  the  appropriate 
services  according  to  vacancies  in  wards.  This  involves  the  abrogation  of 
the  inelastic  rule  regarding  rotation. 

A  second  solution  would  include  the  above  and,  in  addition,  the  estab- 
lishment of  a  fifth  division,  officered  by  a  paid  resident  staff,  into  which 
patients  no  longer  useful  as  teaching  material  could  be  transferred  from  the 
other  divisions.  This  plan  would  involve  empowering  the  Superintendent 
to  effect  transfers  between  divisions.  It  would  also  curtail  the  space  now 
allotted  to  the  existing  divisions. 

A  third  and  more  radical  plan  oft'ers  the  most  complete  solution.  This 
would  involve  the  abolition  of  the  present  divisional  lines  and  the  consoli- 
dation of  the  several  services  now  distributed  among  four  divisions.  Under 
this  plan  there  could  be  no  undue  overcrowding  in  a  single  ward  in  any 
given  service  while  other  wards  of  the  same  kind  are  partly  vacant;  be- 
cause all  the  surgical  wards  would  be  grouped  together,  all  the  medical  in 
one  group,  etc.  There  being  no  divisional  line  separating  one  ward  of  a 
given  group  from  another  ward  of  the  same  group,  admitted  cases  would 
naturally  be  placed  in  vacant  beds  in  any  ward  of  the  group  as  a  matter 
of  convenience  in  administration. 

As  the  administration  of  the  Hospital  under  this  plan  would  have  a  free 
hand  in  distributing  patients  to  the  best  advantage,  it  would  be  practicable 
when  one  service,  the  surgical  for  instance,  became  overcrowded  to  tem- 
porarily transfer  to  the  Surgical  Service  a  ward  belonging  to  a  different 
service,  provided  the  latter  showed  such  a  percentage  of  vacancies  as  would 


374 


HOSPITAL   COMMITTEE 


admit  of  such  a  change.  Temporary  fluctuations  as  between  different  serv- 
ices or  departments  of  the  Hospital  could  thus  be  easily  provided  for,  and 
the  entire  available  space  utilized  to  the  best  advantage,  with  the  minimum 
of  overcrowding  in  any  department.  The  last  suggestion,  however,  may  be 
impracticable  under  existing  conditions. 

The  most  plausible  argument  which  can  be  brought  against  any  of  these 
suggested  plans  is  that  it  would  disturb  the  status  quo  as  between  the  Hos- 
pital and  the  medical  schools,  and  be  inconvenient  to  the  latter.  These 
schools  should  have  every  facility  in  Bellevue  that  is  compatible  with  the 
public  interest,  but  the  efficiency  of  Bellevue  as  an  institution  for  the  care 
of  the  sick  is  paramount  to  all  other  considerations,  and  there  is  no  doubt 
that,  if  a  question  should  arise  as  between  the  best  interests  of  the  de- 
pendent sick  on  the  one  hand  and  the  interests  of  the  medical  schools  on 
the  other,  the  latter  would  be  willing  to  give  way.  There  is  no  question 
that  the  connection  between  a  medical  school  and  a  hospital  is  of  mutual 
benefit,  and  the  schools  should  have  every  encouragement  to  make  full  use 
of  the  clinical  material  in  Bellevue.  They  should  not  expect,  however,  to 
retain  privileges  which  are  not  compatible  with  the  highest  usefulness  of 
the  institution,  nor  can  the  City  with  advantage  to  its  finances  or  its  pa- 
tients turn  over  to  the  schools  practically  complete  control  of  the  adminis- 
tration of  the  wards  of  its  largest  municipal  hospital.  That  the  visiting  and 
house  staffs  should  have  complete  control  of  the  treatment  of  patients  is,  of 
course,  conceded,  but  the  admission,  discharge,  and  distribution  of  patients 
are  administrative  functions  which  the  City  should  control  through  its 
permanent  salaried  officials. 


Table  I. 


Percentages  of  Vacancies  in  Wards. 
Medical  Service^Male  Wards. 


Division  I 

Division  II 

Division  III 

Division  IV 

Capacity 
58  beds 

Capacity 
58  beds 

Capacity 
46  beds 

Capacity 
58  beds 

1912 

3 

M  n) 

^1 

to  d 

1-,     Ui 

era 

-a 

If 

em 

II 

1 
4)  a 

M  ni 

em 

of  Wards  8 

Total  capacity 
220  beds 

ft 

1° 

a;  "3 
< 

fe"o 

ft 

r 

P 

r 

Average  per 
cent,  vacan- 

cies 25.1 

October 

. ..     36.0 

20.9 

23.8 

13.8 

19.3 

8.9 

30,5 

17.7 

November  .... 

..     47.9 

27.9 

13.5 

7.3 

13.0 

6.0 

24.5 

14.2 

Average 
number  vacant 

December 

..     48.3 

28.4 

15.9 

8.6 

9.1 

4.2 

18.8 

10.9 

beds  56.2 

Average 

..     44.3 

17.7 

13.8 

24.6 

DISTRIBUTION  OF  WARD  SPACE 


375 


Table  II. 

Percentages  of  Vacancies  in  Wards. 

Medical  Service — Female  Wards. 


Division  I 

Division  II 

Division  III 

Division  IV 

Capacity 

Capacity 

Capacity 

Capacity 

32  3eds 

26  beds 

19  beds 

26  beds 

.a  <u 

n-l 

of  Wards  8 

J 

em 

o 

am 

tS 

idw 

<u 

gw 

?.  9 

3  .w 

„,-q 

..^ 

Total  capacity 

1912 

II 

¥ 

103  beds 

g^ 

>  o 

fe  ° 

g"o 

iH  ^^ 

fe° 

^•3 

Average  per 

P< 

< 

(U 

< 

ft      ° 

<; 

ft 

< 

cent,  vacancies 

20.3 

October 

..     42.2 

13. S 

9.6 

2.5 

4.2 

.8 

18.8 

4.9 

November .  .  . . 

..     43.1 

13.8 

20.0 

5.2 

10.5 

2.0 

15.4 

4.0 

Average 
number  vacant 

December 

..     36.6 

11.7 

23.5 

6.1 

6.8 

2.3 

12.7 

3.3 

beds  17.3 

Average 

..     40.6 

17.7 

7.2 

15.6 

Table  III. 
Percentages  of  Vacancies  in  Wards. 
Genito-xirinary  Service — Male  Wards. 


Division  I 

Division  II 

Division  III 

Division  IV 

Capacity 

Capacity 

Capacity 

Capacity 

18  beds 

25  beds 

18  beds 

18  beds 

' 

of  Wards  4 

jj-a 

OJTS 

«T3 

OJTd 

S 

am 

.2 

am 

M     sm 

.2 

am 

1912 

1^ 

^g 

li 

3  *J 

age 
cane 

;Nu 
cant 

Total  capacity 
79  beds 

§> 

^> 

1^ 

^^ 

g^       1^ 

l> 

^> 

r 

< 

ft 

V 

53  o       ^  o 
ft          < 

ft 

<: 

Average  per 
cent,  vacancies 

27.8 

October 

.      23.9 

4.3 

22.4 

5.6 

36.1       6.5 

28.9 

5.2 

November 

.      13.3 

2.4 

24.4 

6.1 

31.7      5.7 

36.7 

6.6 

Average 
number  vacant 

December 

.      19.4 

3.5 

34.4 

8.6 

33.3      6.0 

28.9 

5.2 

beds  21.9 

Average 

.      18.9 

27.1 

33.7     .... 

31.5 

376 


HOSPITAL   COMMITTEE 


Table  IV. 

Percentages  of  Vacancies  in  Wards. 

Surgical  Service — Male  Wards. 


Division  I 

Division  II 

Division  III 

Division  IV 

Capacity 

Capacity 

Capacity 

Capacity 

48  beds 

41  beds 

44  beds 

51  beds 

' 

' 

' 

' 

u  w 

of  Wards  8 

<UT3 

(U-O 

(u-a 

DT3 

.S 

M 

gm 

fiPQ 

.2 

am 

HCQ 

jj  a 

fs 

EC 

^1 

J)  d 

3-H 

<o  a 

^z^ 

Total  capacity 

1912 

rt  g 

rt  6 

^n 

184  beds 

g> 

s> 

2> 

l> 

< 

PL, 

< 

>  ° 
< 

PL, 

< 

Average  per 
cent,  vacancies 

4.1 

October 

8.1 

3.9 

3,7 

1.5 

10.2 

4.5 

6.1 

3.1 

November 

2.5 

1.2 

.5 

.2 

5.5 

2.4 

•2.1 

1.1 

Average 
number  vacant 

December 

.2 

.1 

.2 

.1 

7.7 

3.4 

*1.8 

.9 

beds  7. 5 

Average 

3.6 

1.5 

7.8 

3.3 

•  Indicates  excess  of  patients. 


Table  V. 
Percentages  of  Vacancies  in  Wards. 
Surgical  Service — Female  Wards. 


Division  I 

Division  II 

Division  III 

Division  IV 

Capacity 

Capacity 

Capacity 

Capacity 

18  beds 

18  beds 

20  beds 

15  beds 

Total  number 

*■ 

1 

' 

' 

* 

of  Wards  4 

OJ-O 

S 

.1 

B   g 

It 

P.m 

fiCQ 

CJ 

em 

2 

Hm 

1912 

^  o 

< 

lg 
1° 

3  -g 

J)  c 

S'g 

a  4J 

2> 
>  ° 
< 

lg 
g> 
|o 

< 

Total  capacity 
71  beds 

Average  per 
cent,  vacancies 

14.4 

October 

..    17.2 

3.1 

13.9 

2.5 

24.5 

4.9 

9.3 

1.4 

November . . . . 

...       9.4 

1.7 

16.1 

2.9 

21.0 

4.2 

8.7 

1.3 

Average 
number  vacant 

December  .  . . 

..       7.2 

1.3 

15.0 

2.7 

27.5 

5.5 

2.7 

.4 

beds  10.6 

Average 

..     11.3 

15.0 

24.3 

6.9 

DISTRIBUTION  OF  WARD  SPACE 


377 


Tablk  VI. 
Percentages  of  Vacancies  in^Wards. 
Surgical  Service — Children's  Wards. 


Division  I 

Division  II 

Division  III 

Division  IV 

Capacity- 

Capacity 

Capacity 

Capacity 

is  beds 

14  beds 

17  beds 

6  beds 

Total  number 

» 

' 

' 

of  Wards  4 

aj-O 

cj-a 

ajTS 

oj-a 

.1 

i 

Sol 
«  o 

g> 

1 

53° 

1912 

"I 

am 

am 

acq 

Total  capacity 
52  beds 

Average 

A 

<l 

p^ 

< 

p< 

< 

fv. 

< 

per  cent,  excess 

patients  10.4 

October 

..     *6.1 

*1.0  *25.0 

*3.S 

13.3 

.8 

November. . . . 

..     'S-O 

*1.2 

*47.1 

*6.6 

12.4 

2.1 

*6.6 

.4 

Average 
number  excess 

December 

..     20.0 

4.2 

7.1 

1.0 

22.3 

3.8 

patients  3.1 

Average 

..       1.7 

*21.7 

11.6 

4.4 

*  Indicates  excess  of  patients. 


378 


HOSPITAL   COMMITTEE 


Table  VII. 
Comparison  of  Vacancies  in  Male  Medical  and  Surgical  Wards,  Division  I. 


December,  1912 


1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 

21 

22 

23 

24 

25 

26 

27 

28 

29 

30 

31 


Wards  A4  and  B4 
Capacity  58 


Census   Vacant  beds 


22 
21 
26 
25 
27 
26 
28 
31 
31 
28 
31 
31 
27 
29 
32 
32 
32 
34 
30 
30 
31 
31 
29 
30 
31 
30 
31 
30 
32 
32 
37 


36 
37 
32 
33 
31 
32 
30 
27 
27 
30 
27 
27 
31 
29 
26 
26 
26 
24 
28 
28 
27 
27 
29 
28 
27 
28 
27 
28 
26 
26 
21 


Average  vacancies  48 . 3% 


Wards  8  and  9 
Capacity  48 


Census 


47 
48 
50 
52 
49 
46 
45 
43 
41 
48 
47 
51 
50 
50 
51 
50 
51 
47 
48 
47 
50 
47 
46 
49 
47 
47 
48 
50 
48 
45 
48 


Excess        Vacant  beds 


Average  vacancies    .2%. 


Table  VIII. 

Vacancies  in  Wards,  October-December,  1912. 

Summary. 


Surgical  Service: 

Total  Capacity 255  beds 

Average  Vacancies 12  beds 

Medical  Service: 

Total  Capacity 323  beds 

Average  Vacancies 77  beds 

Genilo-urinary  Service 

Total  Capacity 79  beds 

Average  Vacancies 21  beds 


DISTRIBUTION  OF  WARD  SPACE 


379 


Table  IX. 

Local  Overcrowding  in  Divisions  of  the  Same  Service. 

Surgical  Servce — Male  Wards. 


Division  I  Division  II  Division  III  Division  IV 

Wards  8  and  9     Wards  13  and  14     Wards  2  and  3     Wards  17  and  40 
December,  1912       Capacity  48  Capacity  41  Capacity  44  Capacity  51 


' 

m 

" 

^ 

' 

m 

' 

m 

rn^ 

' 

s 

m  a 

3 

V    ° 

=1 

w  C 

Sis 

!f!v; 

6 

«l 

h" 

o 

W(5 

^m 

w" 

o 

^k 

O 

W(2 

h" 

12th 

51 

3 

43 

2 

36 

8 

50 

1 

13th 

50 

2 

40 

1 

35 

9 

53 

2 

14th 

50 

2 

42 

1 

38 

6 

53 

2 

15th 

51 

3 

40 

1 

40 

4 

52 

1 

16th 

60 

2 

39 

2 

36 

8 

61 

17th 

51 

3 

42 

1 

39 

5 

53 

2 

Table  X. 

Local  Overcrowding  in  Divisions  of  the  Same  Service. 

Surgical  Service — Children's  Wards. 


October,  1912 


Division  I 

Ward  7 
Capacity  15 


Division  II 

Ward  16 

Capacity  14 


Division  III 

Wardl 
Capacity  17 


Division  IV 

Ward  12 

Capacity  6 


8.2 


O      Wc 


16th 

....  17 

2 

17th 

....  17 

2 

18th 

....  17 

2 

19th 

....   14 

20th 

....   16 

1 

21st 

....   17 

2 

22nd 

17 

2 

23rd 

....   18 

3 

24th 

....  18 

3 

25th 

....  17 

2 

18 

4 

17 

3 

16 

2 

17 

3 

17 

3 

18 

4 

20 

6 

20 

6 

22 

8 

21 

7 

18    1 

4 

17   ... 

3 

18   1 

3 

17   ... 

4 

17   ... 

4 

17   ... 

4 

17   ... 

3 

16   ... 

1    4 

16   ... 

1    4 

16   ... 

1    5 

38o 


HOSPITAL   COMMITTEE 


Table  XI. 

Local  Overcrowding  in  Divisions  of  the  Same  Service, 
Surgical  Service — Children's  Wards. 


Division  I 

Division  II 

Division  III 

Division  IV 

Ward  7 

Ward  16 

Wardl 

Ward  12 

November,  1912 

Capacity  15 

Capacity 

14 

Capacity  17 

Capacity  6 

O 

Excess 
Patients 

Excess 
Beds 

i 

a 

6 

i  0 

1 

Excess 
Patients 

Excess 
Beds 

3 

6 

Excess 
Patients 

Excess 
Beds 

9th 

12 

...      3 

24 

10 

15 

...       2 

8 

2       ... 

lOth 

12 

...       3 

24 

10 

15 

...       2 

9 

3       ... 

11th 

n 

...       4 

24 

10 

15 

...       2 

8 

2       ... 

12th 

12 

...       3 

22 

8 

16 

...       1 

7 

1       ... 

13th 

13 

...       2 

23 

9 

17 

8 

2       ... 

Table  XII. 

Average  Percentage  of  Vacancies  in  Wards  Compared  with  the  Number 
OF  Days  When  Same  Wards  Were  Full  or  Overcrowded. 


Average  Percentage  of  Vacancies 


Total  Number  of     Number  of  Days 

Number  Days  Wards     Per  100  When 

of  Days  Were  Full     Wards  Were  Full 


5%  and  under 

From  5%  to  10%. 
From  10%  to  15%. 
From  15%  to  20%. 
From  20%  to  25%. 
From  25%  to  30%- 
From  30%  to  35%. 
From  35%  to  40%. 
From  40%  to  45%. 
From  45%  to  50%. 

From  12%  to  15%. 


367 

149 

40 

461 

187 

40 

304 

47 

15 

491 

30 

6 

215 

5 

2 

123 

1 

1 

154 

3 

1 

92 

61 

91 

305 


'  The  maximum  additional  beds  were  2  beds  on  4  occasions. 


4.  TRANSFER  OF  PATIENTS  TO  AND  FROM  BELLEVUE 

HOSPITAL  AND  TO  AND   FROM   KINGS 

COUNTY  HOSPITAL 


GENERAL    STATEMENT 

An  examination  has  been  made  of  the  transfers  to  and  from  Bellevue 
Hospital,  and  to  and  from  Kings  County  Hospital,  with  a  view  of  deter- 
mining to  what  extent  the  beds  of  these  Hospitals,  and  more  especially 
Bellevue,  are  occupied  by  patients  that  remain  too  short  a  time  for  any 
adequate  treatment.  The  admission  and  discharge  of  these  patients  require 
much  clerical  and  other  labor,  and  inasmuch  as  these  patients  receive  no 
adequate  treatment  before  transfer  from  one  hospital  to  another,  it  would 
seem  that  much-needed  space  is  thus  occupied,  and  much  additional  labor 
is  performed,  without  securing  curative  results. 

To  determine  the  extent  to  which  such  transferring  is  carried  on  the 
records  of  these  two  Hospitals  were  examined  for  the  3  months  of  Octo- 
ber, November,  and  December,  191 1.  From  the  records  was  copied  in- 
formation which  indicated  the  place  from  which  each  patient  was  re- 
moved; the  ambulance  transferring  each  patient  to  Bellevue  or  Kings 
County  Hospital ;  time  of  arrival  in  the  Hospital ;  admission  and  diagnosis ; 
time  of  discharge;  and  institution  to  which  the  discharge  was  made.  The 
data  has  been  compiled  under  two  main  headings :  first,  relating  to  the 
patients  transferred  to  these  Hospitals,  of  which  there  were  1,597  to  Belle- 
vue and  172  to  Kings  County  Hospital;  second,  relating  to  the  patients 
transferred  from  these  Hospitals,  of  which  there  were  1,723  from  Bellevue 
Hospital  and  562  from  Kings  County  Hospital. 

The  data  has  been  arranged  in  the  form  of  tables,  which  set  forth  the 
transfers  grouped  as  follows : 

Medical — acute  and  chronic 

Fractures 

Other  Surgical  Cases 

Genito-urinary 

Gynecological 

Obstetrical 

Children 

Alcoholics 

Insane 

Tuberculosis 

Contagious  Diseases 

In  the  acute  medical  class  have  been  placed  all  the  cases  that  did  not 
clearly  appear  to  be  chronic  medical,  or  to  fall  into  one  of  the  other  classes. 
A  close  inspection  of  the  records  might  alter  the  number  of  cases  in  this 
class.  The  surgical  cases  have  been  divided  into  two  classes ;  namely,  frac- 
tures and  other  surgical  cases.    The  other  classes  are  obvious. 


383 


THE    INVESTIGATION 
Transfer  of  Patients  to  and  from  Bellevue  Hospital 


Patients  Received 

For  the  3  months  ended  December  31,  191 1,  1,597  patients  were  re- 
ceived at  Bellevue  Hospital  from  other  hospitals  in  Manhattan  and  The 
Bronx.  Almost  all  of  these  came  from  seven  hospitals:  Flower,  New 
York,  House  of  Relief,  St.  Vincent,  Presbyterian,  Gouverneur,  and  Re- 
ception, and  most  of  them  came  from  the  first  four  hospitals.  Of  the  total 
number  of  patients,  428,  or  26.8  per  cent.,  came  direct  from  these  various 
hospitals  to  Bellevue;  592,  or  37.1  per  cent.,  from  their  residences;  472, 
or  29.5  per  cent,  were  picked  up  in  the  streets;  and  105,  or  6.6  per  cent., 
came  from  police  stations.  These  figures  appear  in  Table  I  on  an  accom- 
panying page. 

Character  of  Sickness 

Of  the  1,597  patients  transferred  to  Bellevue,  the  alcoholics  constituted 
the  most  numerous  class,  there  having  been  a  total  of  433,  or  27.1  per  cent.; 
95,  or  6  per  cent.,  were  classed  as  insane;  176,  or  ii.i  per  cent.,  as  tuber- 
culous; 387,  or  23.6  per  cent,  were  medical  cases;  and  362,  or  23.3  per 
cent.,  surgical  cases.  The  other  144,  or  9  per  cent.,  were  cases  of  a  miscel- 
laneous character.  The  details  for  the  various  hospitals  will  be  found  in 
Table  II. 

Disposition  of  Cases 

Of  the  1,597  patients  transferred  to  Bellevue,  970,  or  60.7  per  cent.,  were 
discharged  to  their  homes;  329,  or  20.5  per  cent.,  were  transferred  to  the 
institutions  of  the  Department  of  Public  Charities  on  Blackwell's  Island; 
131,  or  8.2  per  cent.,  were  transferred  to  various  institutions,  most  of  them 
to  hospitals  for  the  insane;  and  167,  or  10.5  per  cent.,  died  at  the  Hospital. 
Omitting  those  from  one  or  two  hospitals,  the  death  rate  was  considerably 
less  than  10  per  cent. 

Length  of  Stay  in  Bellevue 

The  details  in  regard  to  the  length  of  stay  will  be  found  in  Table  III, 
which  shows  the  length  of  stay  by  character  of  sickness,  and  by  disposi- 
tion. 

It  appears  from  this  table  that  112  patients,  or  7  per  cent.,  were  dis- 
charged the  same  day  received;  165,  or  10.3  per  cent.,  were  discharged 
the  day  after;  562,  or  35.2  per  cent.,  were  discharged  in  from  2  to  4  days — 
a  total  of  52.2  per  cent,  that  remained  in  Bellevue  less  than  4  days. 

Of  the  970  patients  discharged  to  their  homes,  154,  or  15.9  per  cent., 
were  discharged  within  24  hours;  340,  or  35  per  cent.,  were  discharged  in 

385 


386  HOSPITAL   COMMITTEE 

from  2  to  4  days — a  total  of  50.9  per  cent,  that  remained  less  than  4  days. 
Of  the  329  discharged  to  the  Blackwell's  Island  institutions,  81,  or  24.8  per 
cent.,  were  transferred  within  24  hours;  no  were  transferred  in  from  2 
to  4  days — showing  that  nearly  50  per  cent,  of  those  transferred  to  Black- 
well's  Island  were  transferred  within  4  days. 

The  total  death  rate  among  the  patients  was  10.5  per  cent,  or  167  of 
the  total  number  received.  Of  these,  16  patients  died  the  same  day  re- 
ceived; 24  others  died  within  i  day;  and  52  others,  or  31.1  per  cent,  of  the 
total,  died  within  4  days.  This  would  seem  to  indicate  that  a  number  of 
cases  had  been  transferred  in  a  very  critical  condition,  or  that  the  distance 
of  transfer  had  a  serious  effect  on  the  patient's  illness.  The  latter  is  ap- 
parently brought  out  by  the  fact  that  the  death  rate  was  largest  among  the 
patients  coming  from  the  northern  part  of  Manhattan.  If  the  patients 
from  two  hospitals  situated  north  of  59th  Street  are  eliminated  from  the 
figures,  the  death  rate  would  have  been  less  than  9  per  cent.,  a  normal  death 
rate  for  hospital  cases. 

Transfer  of  Patients  from  Bellevue  Hospital 

The  number  of  patients  transferred  from  Bellevue  Hospital  during  the 
3  months  under  consideration,  including  Bellevue  cases,  was  1,723.  Of 
these,  1,317  originated  in  Bellevue,  and  406  came  from  other  hospitals. 
(Table  IV.) 

Character  of  Sickness 

Of  these  1,723  patients,  680  were  classed  as  insane  and  435  as  tubercu- 
lous, or  64.6  per  cent,  of  the  total  number.  Of  the  other  patients,  207  were 
chronic  medical  cases,  and  the  others  were  medical  and  surgical  cases  of  a 
general  character,  including  some  children  and  alcoholics.  Of  the  total,  73 
were  transferred  the  same  day  they  were  received  and  34  others  were 
transferred  within  24  hours,  making  a  total  of  107  patients  transferred  the 
same  day  they  were  received  or  the  day  after.  In  addition,  863,  or  50 
per  cent,  of  the  total,  were  transferred  within  4  days.  Of  these,  432  were 
classed  as  insane ;  285  as  tuberculous ;  and  146  as  medical,  surgical,  and 
other  miscellaneous  cases.     (Table  V.) 

During  the  3  months  487  cases,  exclusive  of  tuberculosis,  were  trans- 
ferred to  the  institutions  on  Blackwell's  Island.  Of  these  cases,  65  were 
transferred  within  24  hours  after  being  received  at  Bellevue,  and  1 15 
others  within  4  days ;  that  is,  a  total  of  180  patients,  or  36.9  per  cent,  of 
those  transferred  to  Blackwell's  Island,  remained  in  Bellevue  less  than  4 
days.  (Table  VI.)  The  chronic  medical  constituted  the  largest  class 
of  those  transferred,  having  been  42  per  cent,  of  the  total.  The  others 
were  medical  and  surgical  cases  of  a  general  character,  including  48  cases 
classed  as  alcoholics. 

Changes  in  the  Practice  of  Transferring  Patients 

It  may  be  assumed  that  the  transfer  of  patients  from  one  hospital  to 
another  is  undesirable,  and  should  be  avoided  as  much  as  possible.  Aside 
from  special  classes  of  cases  which  can  best  be  cared  for  in  a  special  de- 
partment connected  with  a  large  central  institution  the  aim  should  be  to 
place  a  sick  person  at  once  in  the  institution  where  permanent  care  is  to 
be  given.    If  this  general  statement  is  correct,  the  present  practice  of  trans- 


TRANSFER   OF  PATIENTS  387 

ferring  patients  to  Bellevue  and  then  retransferring  them  to  institutions  on 
Blackwell's  Island  should  be  modified  in  several  respects. 

The  analysis  in  Table  VI  shows  that  of  the  1,723  patients  transferred 
from  Bellevue  in  the  3  months  under  consideration  680  were  classed  as  in- 
sane. As  special  provisions  have  been  made  at  Bellevue  for  the  examina- 
tion and  temporary  care  of  the  alleged  insane  before  their  commitment  to 
insane  hospitals,  the  transfer  of  this  class  of  patients  first  to  Bellevue  and 
then  to  the  State  hospitals  for  the  insane  cannot  be  avoided. 

Tuberculous  patients  form  another  large  class  of  those  transferred,  435 
having  been  transferred  in  the  3  months,  jg  of  whom  had  been  received 
from  other  hospitals,  and  356  were  Bellevue  cases.  It  was  found  that  285, 
or  65.5  per  cent,  of  the  total,  remained  in  Bellevue  less  than  4  days,  and  88, 
or  20.2  per  cent.,  from  5  to  9  days.  This  indicates  that  no  attempt  is  made 
to  give  permanent  care  to  this  class  of  patients  at  Bellevue  Hospital,  and, 
excepting  those  whose  condition  is  such  as  to  require  immediate  care,  such 
patients  should  be  transferred  direct  to  Metropolitan  Hospital.  This  would 
reduce  the  number  kept  at  Bellevue,  and  thus  provide  room  for  other 
classes  of  cases. 

Excepting  tuberculosis  cases,  487  patients  were  transferred  from  Belle- 
vue to  Blackwell's  Island.  Of  these,  the  chronic  medical  constituted  the 
most  numerous  class,  with  207  cases.  Apparently  this  class  of  patients  is 
given  only  temporary  relief  at  Bellevue  before  being  transferred,  as  indicated 
by  the  fact  that  19  were  transferred  the  same  day  they  were  received  at 
Bellevue  or  the  day  after.  There  were  52  transferred  in  from  2  to  4  days, 
and  56  in  from  5  to  9  days.  Of  these  108  cases,  only  38  came  from  other 
hospitals,  and  70  were  Bellevue  cases.  Of  the  acute  medical,  43  cases  were 
transferred  within  9  days,  of  which  8  came  from  other  hospitals.  Of  the 
fracture  cases,  37  were  transferred  within  9  days,  12  of  which  came  from 
other  hospitals.  Of  the  whole  number  of  cases,  over  250  were  Bellevue 
patients ;  the  rest  were  patients  received  at  Bellevue  from  other  hospitals 
and  retransferred  to  Blackwell's  Island  institutions. 

The  main  reason  for  the  transfer  of  these  patients  must  be  sought  in  the 
overcrowded  condition  at  Bellevue,  which  necessitates  the  transfer  of  many 
patients  after  a  few  days  treatment  so  as  to  make  room  for  other  patients 
needing  immediate  care.  To  avoid  the  numerous  transfers  from  Bellevue, 
as  many  as  possible  of  the  patients  who  ultimately  go  to  Blackwell's  Island 
for  permanent  care  and  treatment  should  be  sent  there  directly  without  first 
being  admitted  to  Bellevue. 

This  direct  transfer  of  patients  from  hospitals  to  Blackwell's  Island  in- 
stitutions applies  especially  to  chronic  medical  cases.  Some  of  these  may  be 
in  such  condition  as  to  require  immediate  care,  but  the  majority  of  them 
could  just  as  well  be  transferred  direct  from  the  various  hospitals  to  Black- 
well's Island.  The  patients  in  this  class  received  at  Bellevue  should  be  trans- 
ferred at  once  to  Blackwell's  Island,  so  far  as  their  condition  will  permit. 
Suitable  regulations  could  be  drawn  up  and  sent  to  the  various  hospitals 
transferring  patients  to  Bellevue,  defining  in  a  general  way  the  class  that 
should  be  sent  to  Bellevue  and  those  that  should  be  sent  direct  to  Black- 
well's Island.  The  cases  sent  to  Bellevue  should  include  only  such  acute 
cases  as  require  immediate  medical  care  and  attention. 

An  exception  to  this  general  rule  may  be  made  for  the  patients  trans- 
ferred from  the  northern  part  of  Manhattan.  An  examination  of  Table  I 
shows  that  407  cases  were  transferred  from  Flower  Hospital,  and  121  from 


388  HOSPITAL    COMMITTEE 

the  Presbyterian  Hospital,  during  the  3  months.  The  death  rate  among 
these  from  the  former  hospital  was  17.7  per  cent.,  and  from  the  latter  11.6 
per  cent.,  either  of  which  being  higher  than  was  found  among  the  patients 
coming  from  other  hospitals ;  this  can  be  partly  explained  by  the  fact  that 
these  patients  are  transferred  a  greater  distance.  However,  it  does  not  seem 
wise  to  transfer  most  of  these  patients  to  Bellevue,  alcoholics  and  alleged 
insane  excepted,  and  then  retransfer  them  to  Blackwell's  Island  so  long 
as  they  may  be  transferred  direct  to  Blackwell's  Island  by  the  70th  Street 
Ferry.  This  ferry  is  now  used  for  the  transfer  of  many  patients  from 
the  small  Reception  Hospital  at  the  foot  of  East  70th  Street  and  the 
ambulance  district  attached  thereto,  and  is  found  to  work  fairly  well.  It 
should  be  used  also  for  the  transfer  of  patients  from  the  upper  part  of 
Manhattan,  so  as  to  avoid  the  long  transportation  to  Bellevue. 

The  suggested  modifications  in  the  practice  of  transferring  patients  in- 
clude, then,  the  direct  transfer  to  Blackwell's  Island  institutions  of :  first, 
tuberculous  patients,  excepting  those  in  a  critical  condition ;  second, 
chronic  medical  and  other  classes  of  patients,  in  accordance  with  regulations 
to  be  sent  to  the  various  hospitals ;  third,  all  patients  from  the  northern  part 
of  Manhattan,  alcoholics  and  insane  excepted,  who  can  be  sent  to  the  Re- 
ception Hospital  and  transferred  by  the  70th  Street  ferry. 


Transfer  of  Patients  to  and  from  Kings  County  Hospital 

Patients  Received 

The  number  of  patients  transferred  to  Kings  County  Hospital  from 
other  hospitals  in  Brooklyn  and  Queens  for  the  3  months  under  considera- 
tion was  172.  Of  this  number,  68,  or  nearly  40  per  cent.,  came  from  Brad- 
ford Street,  Coney  Island,  and  Cumberland  Street  Hospitals,  which  are 
under  the  jurisdiction  of  the  Department  of  Public  Charities.  The  other 
60  per  cent,  came  from  the  various  private  hospitals  of  the  boroughs.  The 
greatest  number  from  any  one  of  these  latter,  16,  came  from  Williams- 
burgh  Hospital.     (Table  VIII.) 

Character  of  Sickness 

Of  these  172  patients  received  at  Kings  County  Hospital,  61,  or  35.5  per 
cent.,  were  classed  as  alcoholics;  14  as  tuberculous;  and  3  as  insane — a  total 
of  78,  or  45.3  per  cent,  of  the  whole  number.  The  other  94  patients  were 
mainly  medical  and  surgical  cases.     (Table  IX.) 

Disposition  of  Cases 

The  disposition  of  these  patients  was  as  follows  :  98,  or  57  per  cent.,  were 
discharged  to  their  homes;  47,  or  27.3  per  cent.,  died;  11,  or  6.4  per  cent, 
were  sent  to  the  City  Home,  Brooklyn ;  9,  or  5.2  per  cent.,  were  retrans- 
f erred  within  Kings  County  Hospital;  and  7  were  sent  to  various  institu- 
tions. 


TRANSFER   OF  PATIENTS  389 

Length  of  Stay  in  Kings  County  Hospital 
The  average  length  of  stay  of  these  patients  at  Kings  County  Hospital 
was  23  days.  Of  the  total  number,  however,  9  remained  only  i  day  before 
being  discharged ;  64,  or  37.2  per  cent.,  remained  from  2  to  4  days ;  and  33, 
or  19.2  per  cent.,  from  5  to  9  days.  Of  the  47  that  died,  4  had  been  in 
the  Hospital  but  i  day  before  death  occurred ;  6  died  within  48  hours ;  and 
10  others  within  4  days,  aggregating  42.6  per  cent,  of  the  total  number  of 
deaths.     (Table  IX.) 

Transfer  of  Patients  from  Kings  County  Hospital 

In  all,  562  patients  were  transferred  from  Kings  County  Hospital  in  the 
3  months  ended  December  31,  191 1.  Of  this  total,  289,  or  51.4  per  cent., 
were  classed  as  insane  and  transferred  to  insane  hospitals ;  59,  or  10.5  per 
cent.,  were  tuberculous  patients  and  transferred  to  Metropolitan  Hospital 
(Table  X).  Of  the  other  214  patients,  193  were  transferred  to  the  Home 
for  the  Aged  and  Infirm,  Brooklyn,  and  21  to  miscellaneous  institutions 
(Table  XI). 

Transfers  to  the  Home  for  the  Aged  and  Infirm 
Of  the  193  patients  transferred  to  the  Home  for  the  Aged  and  Infirm, 
116  were  general  medical  and  surgical  cases,  mainly  chronic  medical;  26 
were  classed  as  alcoholic;  and  51  were  put  down  as  "non  curata."  Of  these 
"non  curata"  cases  44  were  transferred  to  the  Home  within  i  day;  3  re- 
mained from  5  to  9  days  before  transfer;  and  2  remained  over  10  days. 
(Table  XI.) 


Two  features  stand  out  prominently  from  the  facts  as  stated  above. 
One  is  the  unusually  large  death  rate  among  patients  transferred  to  Kings 
County  Hospital,  and  the  other  is  the  large  number  of  cases  transferred 
from  Kings  County  Hospital  to  the  Home  for  the  Aged  and  Infirm  in 
Brooklyn. 

As  already  stated,  there  was  a  death  rate  of  27.3  per  cent,  among  the  pa- 
tients received  at  Kings  County  Hospital  from  other  hospitals  in  Brooklyn 
and  Queens.  The  death  rate  among  the  1,597  patients  transferred  to  Belle- 
vue  in  the  same  period  was  10.5  per  cent.,  and,  omitting  those  coming  from 
one  hospital,  the  rate  among  1,190  was  less  than  8  per  cent.  The  average 
death  rate  among  hospital  patients  varies,  roughly,  from  7  to  9  per  cent.  A 
death  rate  of  27.3  per  cent,  is,  therefore,  abnormal.  Of  the  21  cases  classed 
as  acute  medical  10  died,  or  about  one-half ;  and  of  the  14  tuberculous 
patients  9  died,  or  nearly  two-thirds  (Table  VIII).  The  facts  stated  lead 
to  one  of  two  conclusions :  Either  the  patients  are  dangerously  ill  when 
transferred,  or  else  the  transfer  for  a  long  distance  has  a  very  aggravating 
effect  on  the  illness  of  the  patients.  In  either  case  steps  should  be  taken 
to  prevent  the  transfer  of  at  least  some  of  these  patients. 

Among  the  193  cases  transferred  to  the  Home  for  the  Aged  and  Infirm 
51  were  classed  as  "non  curata,"  that  is,  patients  apparently  in  no  need  of 
medical  attention.  Of  these,  44  were  transferred  within  i  day.  Of  the 
116  medical  and  surgical  cases  transferred  to  the  City  Home,  12  were 
transferred  within  i  day  and  34  others  in  2  to  4  days  (Table  XI).  There 
is  nothing  shown  in  the  analysis  so  far  made  to  indicate  whether  these  cases 
were  proper  cases  for  admission  to  the  Home,  but,  if  they  were,  they 


390 


HOSPITAL   COMMITTEE 


should  have  been  admitted  direct,  and  not  through  the  Kings  County  Hos- 
pital. There  were  upward  of  loo  of  apparently  improperly  admitted  pa- 
tients occupying  beds  in  the  Hospital  which  should  have  been  for  hospital 
cases,  and  a  strict  medical  examination  should  be  instituted  to  avoid  ad- 
mitting to  the  Hospital  as  many  of  this  class  of  cases  as  possible. 

In  regard  to  the  59  cases  of  tuberculosis  transferred  to  Metropolitan 
Hospital  it  may  be  noted  that  30  had  been  in  the  Hospital  10  or  more 
days,  and  17  from  5  to  9  days.  This  would  indicate  that  Kings  County 
Hospital  is  used  not  as  a  reception  ward  for  the  temporary  care  and  treat- 
ment of  acute  tuberculosis  cases,  as  it  should  be.  A  more  rapid  transfer  of 
these  cases  would  seem  advisable,  or,  better  still,  a  direct  transfer  from 
other  hospitals  or  from  the  residences  of  these  patients  to  Metropolitan 
Hospital. 

TABLE  I. 

Bellevue  Hospital. 

Sources  and  Disposition  of  Patients  Transferred  to  Bellevue  Hospital  from 

Various  Hospitals  During  the  Three  Months  Ended  December  31,  1911. 

The  first  section  0}  this  table  shows  the  numbers  and  percentages  of  the  patients  transferred  to 

Bellevue  Hospital  by  the  ambulances  of  the  Hospitals  indicated  and  whether  they  came  direct 

from  a  hospital,  from  a  residence,  from  the  street,  or  from  a  police  station.     The  second  section 

shows  what  became  of  these  patients  when  discharged  from  Bellevue  Hospital. 


Sources 

Disposition 

a 

■3 

h 

Hospital 

D 

a 

9, 

^ 

M 

s 

a 

tn 

c 

ffi 

c 

r2 

a 
0 

1 

03 

"o 

IS 

0 

yd 

5 

CD    0 
0 

3 

3 
0 

Flower 

232 

20 

116 

39 

407 

246 

53 

19 

17 

72 

407 

New  York .... 

147 

29 

155 

IS 

349 

245 

55 

10 

6 

33 

349 

House  of  Relief 

15 

197 

32 

13 

257 

1.58 

78 

1 

8 

12 

257 

St.  Vincent's .  . 

102 

32 

96 

12 

242 

130 

74 

14 

1 

23 

242 

Presbyterian .  . 

47 

22 

44 

8 

121 

82 

18 

6 

1 

14 

121 

Gouvemeur.  .  . 

29 

48 

10 

12 

99 

36 

86 

20 

1 

6 

99 

Reception 

18 

26 

17 

3 

64 

52 

6 

2 

4 

64 

All  others 

2 

54 

2 

58 

21 

15 

15 

4 

3 

58 

Totals 

592 

428 

472 

105 

1,597 

970 

329 

91 

40 

167 

1,597 

Per 

Per 

Per 

Per 

Per 

Per 

Per 

Per 

Per 

Per 

Per 

Cent. 

Cent. 

Cent. 

Cent. 

Cent. 

Cent. 

Cent. 

Cent. 

Cent. 

Cent. 

Cent. 

Flower 

57.0 

4.9 

28.5 

9.6 

100 

60.4 

13.0 

4.7 

4.2 

17.7 

100 

New  York .... 

42.1 

8.3 

44.4 

5.2 

100 

70.2 

15.8 

2.9 

1.7 

9.4 

100 

House  of  Relief 

5.8 

76.6 

12.5 

5.1 

100 

61.5 

30.4 

.4 

3.1 

4.6 

100 

St.  Vincent's  . . 

42.1 

13.2 

39.7 

5.0 

100 

.53.7 

30.6 

5.8 

.4 

9.5 

100 

Presbyterian .  . 

38.8 

18.2 

36.4 

6.6 

100 

67.8 

14.9 

4.9 

.8 

11.6 

100 

Gouvemeur.  . . 

29.3 

48. 5 

10.1 

12.1 

100 

36.4 

36.4 

20.2 

1.0 

6.0 

100 

Reception 

28.1 

40.6 

26.6 

4.7 

100 

81.2 

9.4 

3.1 

6.3 

100 

All  others 

3.4 

93.1 

3.5 

100 

36.2 

25.9 

25.9 

6.9 

5.1 

100 

Totals 

37.1 

26.8 

29.5 

6.6 

100 

60.7 

20.6 

5.7 

2.5 

10.5 

100 

TRANSFER   OF  PATIENTS 


391 


TABLE  II. 

Bellevue  Hospital. 

Classification  of  Patients  Transferred  to  Bellevue  Hospital  from  Other  Hos- 
pitals During  the  Three  Months  Ended  December  3],  1911. 

This  table  groups  the  patients  according  to  their  diseases  at  the  time  of  transfer  to  Bellevue 
Hospital  and  upon  the  final  disposition  of  their  cases. 


Medical     Surgical 


Received  from 

Residence....  100  95  27  63        6 

Hospital 50  46  57  68        4 

Street 50  26  75  55        6 

Police  station.  10  10  8  9     . . . 

Totals 210  177  167  195 

Discharged  to 

Residence....  128  68  109  141 

City  Hospital.  22  37  22  17 

Met.  Hosp...  10  22  15  21 

City  Home. . .  5  20  1  2 

State  Hosp's 

Other  institu- 
tions    4  2  5  5 

Died 41  28  15  9 

Totals 210  177  167  195 


14 

46 

23 

96 

37 

84 

1  592 

6 

7 

12 

86 

29 

60 

3  428 

4 

6 

3 

199 

21 

26 

1  472 

2 

52 

8 

6 

..  105 

16   24   59   40  433   95  176    5  1597 


32  371 

1  11 

2  9 


91 


16 


59 


5   25 
40  433 


10 

42 


1  970 

. .  120 

. .  172 

. .  37 

. .  91 

4  40 

. .  167 


95  176    5  1597 


392  HOSPITAL   COMMITTEE 


TABLE  III. 

Bellevue  Hospital. 

Length  of  Stay  by  Character  of  Disease  and  Disposition  of  Patients 

Transferred  to  Bellevue  Hospital  from  Other  Hospitals 

During  the  Three  Months  Ended  December  31,  1911. 

The  first  section  of  this  table  shows  the  patients  according  to  their  classification  and  the  length 
of  their  stay  in  Bellevue  Hospital,  in  numbers  and  percentages;  and  the  second  section  shows 
the  disposition  of  the  patients  according  to  the  length  of  their  stay  in  Bellevue  Hospital,  in  numbers 
and  percentages. 


Character  of  Disease 
0  day  1  day       2 — 4  days   5 — 9  days      10  + days 


Num-  Per  Num-  Per  Num-   Per  Num-  Per  Num-  Per  Total, 
ber   Cent,  ber  Cent,    ber  Cent,    ber  Cent,    ber  Cent. 


Per 
Cent. 


Acute  Medical  .... 

..     19 

9.1 

23 

11.0 

49 

23.3 

41 

19.5 

78 

37.1 

210 

100 

Chronic  Medical  .  . 

. .     20 

11.3 

8 

4.5 

46 

26.0 

35 

19.8 

68 

38.4 

177 

100 

Fractures 

. .     11 

6.6 

7 

4.2 

20 

12.0 

39 

23.3 

90 

53.9 

167 

100 

Other  Surgical 

..     29 

14.9 

20 

10.2 

61 

31.3 

36 

18.5 

49 

25.1 

195 

100 

Genito-urinary  .... 

..       3 

18.7 

4 

25.0 

1 

6.3 

2 

12.5 

6 

37.5 

16 

100 

Gynecological 

..       3 

12.5 

2 

8.3 

4 

16.7 

3 

12.5 

12 

50.0 

24 

100 

Obstetrical 

..       3 

5.1 

3 

5.1 

5 

8.5 

16 

27.1 

32 

54.2 

59 

100 

Children 

1 

2.5 

1 

2.5 

10 

25.0 

2 

5.0 

26 

65.0 

40 

100 

Alcoholic 

. .     16 

3.7 

78 

18.0  221 

51.0 

77 

17.8 

41 

9.5 

433 

100 

Insane 

3 

3.1 

47 

49.5 

24 

25.3 

21 

22.1 

95 

100 

Tuberculosis 

..       7 

4.0 

15 

8.5 

95 

54.0 

31 

17.6 

2S 

15.9 

176 

100 

Contagious 

1 

20.0 

3 

60.0 

1 

20.0 

5 

100 

Totals 

. .   112 

7. 

165 

10.3 

562 

35.2 

306 

19.2  452 

28.31,597 

100 

Disposition  of  Patients 

0  day  1  day       2 — 4  days   5 — 9  days    10  + days 

Num-  Per  Num-  Per  Num-  Per  Num-  Per  Num-  Per  Total 
ber    Cent,  ber    Cent,  ber    Cent,  ber    Cent,  ber    Cent. 


Per 
Cent. 


Residence 28  2.9  126  13.0  340  35.0  187  19.3  289  29.8  970  100 

City  Hospital 30  25.0      3  2.5    26  21.7     18  15.0    43  35.8  120  100 

Metropolitan  Hospital    31  18.0      7  4.1     73  42.4    29  16.9    32  18.6  172  100 

City  Home 7  18.9      3  8.1     11  29.8      6  16.2     10  27.0  37  100 

Other  institutions 2  1.5     60  45.8     33  25.2    36  27.5  131  100 

Died 16  9.6    24  14.4    52  31.1     33  19.7    42  25.2  167  100 

Totals 112  7.0  165  10.3  562  35.2  306  19.2  452  28.31,597  100 


TRANSFER   OF  PATIENTS 


393 


TABLE  IV. 

Bellevue  Hospital. 

Number  and  Classification  of  Patients  Transferred  from  Bellevue  Hospital 
During  the  Three  Months  Ended  December  31,  1911. 

Cases  Originating  in  Bellevue  Hospital 


Medical 


Source 


^       ^ 


■2      -a 
a      3 


Residence 

Cab  &  carriage . 
Parents  &  others 

Street 

Walked 

Police 

City  Prison .... 

Totals 


10 

18 

5 

1 

4 

3  ... 

2 

6 

1 

3 

2 

2  ... 

"e 

'is 

is 

"6 

"2 

29 

70 

9 

12 

12 

2  ... 

10 

1 

1 

2 

2 

23 


1 

103 

23 

4 

173 

2 

33 

13 

64 

2 

2 

11 

40 

9 

55 

18 

1 

128 

17 

236 

294 

5 

686 

30 

120 

5 

190 

10 

21 

1 

36 

49     122      31      23      20        7        0      49      69    570    356      211,317 
Cases  Originating  in  Other  Hospitals 


Flower 

4 

14 

4 

9 

1 

1 

2 

18 

16 

...   69 

New  York 

8 

13 

7 

4 

2 

1 

4 

8 

15 

1   63 

House  of  ReUef . 

7 

16 

15 

5 

2 

4 

1 

15 

1   66 

St.  Vincent's..  . 

5 

17 

5 

6 

8 

13 

13 

...   67 

Presbyterian .  . . 

5 

4 

1 

1 

1  . 

1 

10 

...   23 

Gouvemeur .... 

7 

1 

5 

1  . 

i 

19 

13 

...   47 

All  others 

4 

10 

2 

1 

4 

1  . 

1 

41 

7 

...   71 

Totals 

28 

82 

38 

31 

10 

3 

1 

3 

19 

110 

79 

2  406 

■ 

77 

204 

69 

54 

30 

10 

1 

52 

88 

680 

435 

231,723 

394 


HOSPITAL   COMMITTEE 


TABLE  V. 

Bellevue  Hospital. 

Length  of  Stay  in  Bellevue  Hospital  by  Character  of  Disease  of  the  Patients 

Transferred  to  Other  Institutions  During  the  Three  Months 

Ended  December  31,  191L 

0  day  1  day       2 — i  days  5 — 9  days    10  +  days 

Num-  Per  Num-  Per  Num-  Per  Num-  Per  Num-  Per  Total  Cent 
ber  Cent,    ber  Cent,   ber  Cent,    ber  Cent,    ber  Cent. 

Acute  Medical 9     11.8         1     1.3     11     14.2    22    28.6    31     44.1       74  100 

Chronic  Medical 14      6.9        5     2.5     52    25.0    56    25.3     80    40.3    207  100 

Fractures 9     13.0     11     16.0     17    24.7     32     46.3      69  100 

Other  Surgical 14    25.9     15    27.8     11     20.4     14    25.9      54  100 

Gemto-urinary 7     23.4         1     3.3      7    23.3      8    26.7      7    23.3      30  100 

Gynecological 1     10.0     1     10.0       3     30.0       5     50.0       10  100 

Obstetrical 1100.0     1  100 

Children 4      7.7        6  11.5     13    25.0      5      9.6    24    46.2      52  100 

Alcoholic 1       1.2        3     3.4     32     36.3     34    38.6     IS    21.5      88  100 

Insane 1         .2       14     2.1  432     63.5  167     24.5     66       9.7     680  100 

Tuberculosis 3         .7     285     65.5    88    20.2    59     13.6    435  100 

Contagious 9    39.2        4  17.3      4     17.3      3     13.1      3     13.1      23  100 

Totals 73      4.3      34     1.9  863    50.1414    23.7  339    20.01,723  100 


TABLE  VI. 

Bellevue  Hospital. 

Length  of  Stay  in  Bellevue  Hospital  by  Disposition  of  Patients  Transferred  to 

Other  Hospitals  During  the  Three  Months  Ended  December  31,  1911. 

0  day  1  day       2 — 4  days   5 — 9  days    10  + days 

Num-  Per  Num-  Per  Num-  Per  Num-  Per  Num-  Per  Total 
ber  Cent,   ber   Cent,  ber  Cent,   ber  Cent,   ber   Cent. 

Medical  and  Surgical: 
Metropolitan  Hospital  1 

City  Hospital \     55     11.5      9       1.8  115    23.6  128    25.9  180    37.2    487 

City  Home,  Manhattan  J 

Miscellaneous 14     11.6     11       9.1     30    24.8    27    22.3     39    32.2     121 

Totals 69     11.5    20      3.3  145     24.0  155    25.0  219    36.2    608 

Insane: 
State  Hospitals 1         .1     14      2.1432     63.5  167    24.6    66      9.7     680 

Tuberculosis: 

Metropolitan  Hospital...       2  ...  235  78  45  360 

St.  Joseph's  Hospital....       1  ...  29  5  7  42 

St.  Vincent's  Hosp.,  S.I.    ...  ...  12  ...  ...  12 

Riverside  Hospital ...  9  5  7  21 

Totals 3         .7 285    65.5    88    20.2     59     13.6     435 

Total 1,723 

I 

Of  the  121  patients  classed  as  "  Miscellaneous"  23  were  contagious  cases;  52  were  chil- 
dren ;  and  46  alcoholic.  The  contagious  were  all  transferred  to  Reception  Hospital :  the  chil- 
dren to  New  York  Foundling,  New  York  Infant,  Misericordia,  and  Randall's  Island;  and  the 
alcoholics  to  the  workhouse. 


TRANSFER   OF  PATIENTS 


395 


TABLE  VII. 

Bellevue  Hospital. 

Patients  Transferred  from  Bellevue  Hospital  to  Metropolitan  Hospital,  City 

Hospital,  and  City  Home  During  the  Three  Months 

Ended  December  31,  1911. 

This  table  shows  the  kinds  of  disease  and  lengths  of  stay  in  Bellevue  Hospital  of  these 
patients. 

(Tuberculosis  not  included) 


Metropolitan  Hospital 


0    12-4  5-9  10  + 

day  day  days  days  days 


Total 


City  Hospital 


0    12-4  5-9  10  + 

day  day  days  days  days 


Total 


Acute  Medical 5     ...         5        8  11  29  3         1  3  15  20  42 

Chronic  Medical  ..     7     ...       12       17  18  54  3        3  23  26  52  107 

Fractures 3     ...         4         4  11  22  4     ...  5  7  17  33 

Other  Surgical 12     .  . .         6         5  6  29  2     ...  8  S  7  22 

Genito-urinary.  .  .  .     1...         3         2  2  8  6         1  4  4  5  20 

Gynecological 3  3  1...  1  2  1  5 

Obstetrical 1     1 

Children 2  2         1  ...  2  3 

Alcoholic 1  ...    7    6  3  17    11  8  7  26 

Totals 29  ...   37   42  56  164  20   5  56  67  111  259 


City  Home 


Totals  for  These 
Three  Institutions 


Acute  Medical 1     1  9        1  8  23  31  72 

Chronic  Medical. .  .     4        2       17       13       10      46  14        5  52  56  80  207 

Fractures 1      ...         2         2         1         6  8     ...  11  13  29  61 

Other  Surgical 1     ...         1      2  15     . . .  15  10  13  53 

Genito-urinary 1...          1         2  7         1  8  6  8  30 

Gynecological 1         1         2  1...  1  3  5  10 

Obstetrical 1      1 

Children 1  ...  4  5 

Alcoholic 2        1115  1        2  19  15  11  48 

Totals 7        4      22       17       14      64  56        9  115  126  181  487 


396  HOSPITAL   COMMITTEE 


TABLE  VIII. 

Kings  County  Hospital. 

Number  and  Classification  of  Patients  Transferred  to  Kings  County  Hospital 
FROM  Other  Hospitals  During  the  Three  Months  Ended  December  31,  19H. 

This  table  groups  the  patients  according  to  their  diseases  at  the  time  of  transfer  to  Kings 
County  Hospital  and  upon  the  final  disposition  of  their  cases. 


Medical  Surgical  •ftW 

3  >> 


'Eo    "rt 


I     1     I     -^      S     I     S     I     ^     .5  -^ 


Received  from: 

Bradford  Street  Hospital. .       737     12      1..       425..       1..  42 

Brooklyn  Hospital 1 6     ..       1     ..  8 

Bushwick  Hospital 1       1       2 3       1     ..      ..  8 

Coney  Island  Hospital 1      4..       1       1..      ..       1      2..       2..  12 

Cumberland  Street  Hospital      3      1      2      1 4..       3..  14 

Eastern  District  Hospital ..       1       1       1 3      1..      ..  7 

Flushing  Hospital 2 1  3 

German  Hospital 3 3     6 

Jamaica  Hospital 1 1 

L.  I.  College  Hospital 1 1     ..       4     6 

L.  I.  State  Hospital 

Norwegian  Hospital 1      2 8     . .       1     . .  12 

St.  Catherine's  Hospital 1 3       1  5 

St.  John's  Hospital 1..       1 5..     ..       1  8 

St.  Mary's  Hospital 1       3..       1..       1..       1..      ..        1..  8 

Seney  (M.  E.)  Hospital. ...        1       5 3 


Swedish  Hospital 1     1     ..      ..       S     7 

WilUamsburgh  Hospital. .. .       2     ..       1 10      1      2     ..  16 

Totals 21     27     13     17      2      2      5      4    61       3     14      3  172 

Discharged  to: 

Residence 10     12     10     15      2       1      4      2    40     . .       2     ..  98 

L.  I.  State  Hospital 1     . .      . .  1 

L.  I.  CoUege  Hospital 1     . .  1 

Metropolitan  Hospital 2     ..  2 

St.  Peter's  Hospital 1 1 

City  Home,  Brooklyn 1      5       1 1..     ..       3  11 

Kings  County  Hospital* 1..       1..      ..       1..       4      2..      ..  9 

Ejngs  County  Hospital 

("Unpaid  Helpers") 2 2 

Died 10      8      2      1     ..       1     ..       2     14     . .       9     ..  47 

Totals 21     27     13     17      2      2      5      4    61      3     14      3  172 


*  Transferred  within  the  Hospital. 


TRANSFER  OF  PATIENTS 


397 


TABLE  IX. 

Kings  County  Hospital. 

Length  of  Stay  by  Character  of  Disease  and  Disposition  of  Patients  Transferred 

TO  Kings  County  Hospital  from  Other  Hospitals  During  the 

Three  Months  Ended  December  31,  1911. 

The  first  section  of  this  table  shows  the  patients  according  to  their  classification  and  the  length 
of  their  stay  in  Kings  County  Hospital,  in  numbers  and  percentages;  and  the  second  section 
shows  the  disposition  of  the  patients  according  to  the  length  of  their  stay  in  Kings  County  Hospital, 
in  numbers  and  percentages. 


Character  of  Disease 
1  day  2 — 4  days       5—9  days        10  + days 

Num-    Per     Num-    Per     Num-    Per     Num-     Per     Total    Cent, 
ber     Cent,     ber     Cent,     ber     Cent,     ber     Cent. 


Acute  Medical. . . 
Chronic  Medical. 

Fractures 

Other  Surgical. . . 
Genito-urinary .  . 
Gynecological.  . . 

Obstetrical 

Children 

Alcoholic 

Insane 

Tuberculosis .... 
No  diagnosis .... 

Totals 9        5.2      64      37.2      33       19.2      66      38.4     172 


1 

5 

0 

6 

28.5 

4 

19.0 

10 

47.5 

21 

100 

1 

3 

8 

6 

22.2 

8 

29.6 

12 

44.4 

27 

100 

1 

7 

7 

1 

7.7 

11 

84.6 

13 

100 

3 

17.6 

3 

17.7 

11 
2 

64.7 
100.0 

17 
2 

100 
100 

1 

50.0 

1 

50.0 

2 

100 

1 

20.0 

1 

20.0 

3 

60.0 

5 

100 

2 

50.0 

2 

50.0 

4 

100 

4 

6 

6 

42 

68.8 

11 

18.0 

4 

6.6 

61 

100 

2 

66.7 

1 

33.3 

3 

100 

2 

14.3 

3 

21.4 

9 

64.3 

14 

100 

2 

66 

7 

1 

33.3 

3 

100 

1  day 


Disposition 
2 — 4  days   5 — 9  days   10  + days 


Per 


Num-     Per    Num-    Per     Num-    Per     Num-    Per     Total   Cent, 
ber     Cent,     ber     Cent,     ber     Cent,    ber     Cent. 


Residence 

3 

3.0 

36 

36.7 

15 

15.3 

44 

44.9 

98 

100 

City  Home,  B'klyn. . . 

2 

18.2 

5 

45.4 

1 

9.1 

3 

27.3 

11 

100 

Kings  County  Hosp . . 

3 

33.3 

1 

11.1 

5 

55.6 

9 

100 

All  others 

•A 

43.0 

1 

14.0 

3 

43.0 

7 

100 

Died 

4 

8.5 

16 

34.1 

15 

31.9 

12 

25.5 

47 

100 

Totals 

9 

5.3 

63 

37.2 

33 

19.2 

67 

38.3 

172 

100 

398  HOSPITAL   COMMITTEE 


TABLE  X. 

Kings  County  Hospital. 

Number  and  Classification  of  Patients  Transferred  from  Kings  County  Hospital 
During  the  Three  Months  Ended  December  31,  1911. 


Medical     Surgical 


'g   I    s    §   2    I   I 

o    fo    o     o    o     o    < 


Transferred  to: 

B'klyn  Home  for  Consumptives 1     ..  1 

Angel  Guardian  Home 5 5 

Central  Islip  State  Hospital 25     ..      ..  2.5 

City  Home,  Brooklyn 12    91      3     10 26     . .      . .     51  193 

Combes  Sanitarium 1     . .      . .  1 

Farm  Colony 1 1 

Hudson  River  State  Hospital 1     ..      ..  1 

Kings  Park  State  Hospital 180     ..      ..  180 

Long  Island  State  Hospital 1       1     76     . .      . .  78 

Metropolitan  Hospital 3 54     . .  67 

New  York  Foundling  Hospital 1       1 2 

Queens  County  Jail 1     . .      . .  1 

Randall's  Island 5     . .     . .  5 

St.  Mary's  Hospital 1 1 

St.  Joseph's  Hospital 1     ..  1 

St.  Joseph's  Home,  Flushing 1 1 

St.  Peter's  Hospital 1 2     ..  3 

St.  Rose's  Cancer  Home,  Mhtn 2      1 3 

Seney  Hospital 1     ..       1 1     ..  3 

Totals 13    96      4     13      3      1      7    26  289    59     51  562 


TRANSFER   OF  PATIENTS 


399 


TABLE  XI. 

Kings  County  Hospital. 

Length  of  Stay  in  Kings  County  Hospital  by  Disposition  and  Character  of  Disease 

OF  Patients  Transferred  to  Other  Hospitals  During  the  Three 

Months  Ended  December  31,  1911. 


1  day  2 — 4  days       5 — 9  days        10+ days 

Num-     Per    Num-    Per     Num-    Per    Num-    Per     Total    Cent, 
ber     Cent,     ber     Cent,     ber     Cent,     ber     Cent. 


State  Hospitalsjnsane    39 
Metrop'tan  Hosp.,Tbc 
City  Home,  B'klyn... 
Miscellaneous 

Totals 100       18.0     169      30.0      94      16.7     199      35.3    S62 


39 

13.5 

97 

33.6 

44 

15.2 

109 

37.7 

289 

100 

12 

20.4 

17 

28.8 

30 

50.8 

59 

100 

.W 

30.0 

58 

30.0 

32 

16.7 

45 

23.3 

193 

100 

3 

14.3 

2 

9.5 

1 

4.8 

15 

71.4 

21 

100 

100 


Classification  of  One  Hundred  and  Ninety-three  Cases  Transferred 
to  City  Home,  Brooklyn. 


1  day  2 — 4  days  5 — 9  days  10+ days 

Num-    Per  Num-    Per  Num-    Per  Num-    Per  Total  Cent. 

ber     Cent,  ber     Cent,  ber     Cent,  ber     Cent. 

Medical 12      11.7  30      29.1  28      27.2  33      32.0  103  100 

Surgical 4      30.8       9      69.2  13  100 

Alcoholic 2        7.8  22      84.6  1        3.8  1        3.8  26  100 

"NonCurata" 44      86.3  2        3.9  3        5.9  2        3.9  51  100 

Totals 58      30.0  58      30.0  32       16.5  45      23.5  193  100 


5.  THE  MORGUE   SERVICE 


THE  INVESTIGATION 

The  morgue  service  throughout  the  City  of  New  York  is  conducted  by 
the  Commissioner  of  Public  Charities. 

The  morgue  building  is  located  on  the  grounds  of  Bellevue  Hos- 
pital. Although  located  on  the  Bellevue  grounds,  it  is  still  under  the 
management  and  control  of  the  Commissioner  of  Charities,  for  when  Belle- 
vue and  its  allied  hospitals  were  separated  from  the  Department  of  Public 
Charities  in  1902  the  separation  did  not  carry  with  it  the  management  of  the 
morgue  adjoining  Bellevue.  It  has  been,  and  still  is,  necessary  to  transfer 
all  dead  bodies  from  Bellevue  Hospital  to  the  morgue  under  the  control  of 
the  Commissioner  of  Charities. 

This  morgue  received  11,697  bodies  during  the  year  191 1.  This  num- 
ber included  bodies  from  the  correctional  institutions,  and  also  515  from 
Manhattan  State  Hospital.  Of  the  total  number  received,  5,509  were 
claimed  and  buried  by  friends,  5,456  were  buried  by  the  City,  and  732 
were  transferred  to  institutions  for  anatomical  purposes. 

The  building  used  as  a  morgue  has  for  a  number  of  years  been  inade- 
quate to  handle  the  large  number  of  bodies  received  and  discharged  from 
it.  Owing  to  this  fact,  when  the  pathological  building  at  Bellevue  was 
planned  it  was  deemed  wise  to  incorporate  in  it  an  adequate  morgue. 
Accordingly,  space  was  set  aside  for  this  purpose,  and  it  was  subsequently 
completely  equipped.  This  new  morgue  has  coolers  with  a  capacity  for 
225  bodies;  a  general  autopsy  room  containing  six  slabs;  one  private 
autopsy  room ;  two  autopsy  rooms  for  the  use  of  coroners'  physicians ;  an 
undertaker's  class  room,  with  4  operating  tables;  and  an  undertaker's  em- 
balming room,  with  4  tables.  There  is  also  an  exhibition  room  containing 
24  cases  for  the  display  of  unknown  dead,  and  there  is  a  chapel  wherein 
obsequies  may  be  held.  The  provisions  are  probably  more  ample  than  will 
be  needed  for  many  years  to  come,  and  yet  it  was  probably  wise  in  plan- 
ning the  morgue  to  provide  space  for  the  growing  needs  of  the  City. 

Inasmuch  as  the  Bellevue  authorities  apparently  have  not  power  to 
operate  a  general  morgue,  this  morgue  on  completion  was  offered  to  the 
Commissioner  of  Charities  for  operation.  The  Commissioner  of  Charities 
in  reply  to  this  offer  on  January  26,  1912,  addressed  a  communication  to  the 
Board  of  Trustees  of  Bellevue  Hospital,  asking  what  portion  of  the  building 
was  tendered  for  his  use;  whether  the  Trustees  would  heat  and  light  the 
building  and  furnish  refrigeration ;  and  what  would  be  the  extent  of  his  ju- 
risdiction. The  Trustees  replied  on  January  30th,  stating  that  the  space  al- 
lotted to  the  morgue  would  be  under  the  complete  jurisdiction  of  the  Com- 
missioner, and  that  the  Trustees  would  heat,  light,  and  refrigerate  the 
morgue.  On  March  28th  the  Commissioner  replied  to  the  Trustees  that  he 
would  operate  the  morgue  "*  *  *  *  provided  the  title  of  the  said  building 
is  vested  in  the  Department  of  Public  Charities  *  *  *"  Inasmuch  as 
but  a  small  portion  of  the  building  is  occupied  by  the  morgue,  and  the 
remainder  of  the  building  is  devoted  to  laboratories  and  dormitories  used 
by  Bellevue,  the  Trustees  could  not  see  their  way  clear  to  transfer  the  juris- 
diction of  the  whole  building  to  the  Commissioner.  The  Commissioner 
subsequently  concluded  that  he  would  operate  the  morgue  without  the  trans- 
fer of  the  title  of  the  whole  building,  but  no  action  was  taken  on  his  part 
to  secure  appropriations   for  such  operation  until  the  summer  of   1913. 

403 


404 


HOSPITAL   COMMITTEE 


Thus  this  valuable  morgue  property  has  remained  unused  since  completion 
for  a  period  of  more  than  two  years. 

The  new  morgue  being  much  larger  and  more  elaborate  than  the  old 
morgue  would  necessarily  require  considerably  more  employees  to  operate 
it.  The  Commissioner  in  June,  1913,  submitted  to  the  Secretary  of  the 
Borough  of  Manhattan  a  tentative  list  of  helpers  who  in  his  opinion 
would  be  needed  to  properly  operate  the  morgue.  The  aggregate  salaries 
suggested  for  this  list  of  employees  amounted  to  $21,060.  The  cost  of  serv- 
ice in  the  old  morgue  is  approximately  $3,300  per  year. 

It  seems  highly  advisable  that  the  new  morgue  should  be  opened  as 
soon  as  possible  in  order  that  its  splendid  facilities  may  be  put  into  use. 
These  enlarged  facilities  will  necessarily  cost  materially  more  to  care  for 
than  the  limited  space  and  inadequate  equipment  of  the  old  morgue.  It 
seems  unnecessary  and  inadvisable,  however,  to  provide  the  number  of  em- 
ployees and  the  aggregate  amount  of  salary  suggested  by  the  Commis- 
sioner. After  a  careful  survey  of  the  morgue  and  the  functions  to  be  per- 
formed it  is  recommended  that  there  be  appropriated  for  this  purpose  the 
sum  of  $12,480,  to  be  distributed  as  indicated  in  the  following  table,  which 
also  sets  forth  the  request  made  by  the  Commissioner : 

Estimate  of  the  Number  of  Employees  Needed  to  Operate  the  New  Morgue 
AND  Wages  for  Same. 


Estimate  of 
Department  of 
Public  Charities 


Estimate 
Committee 


Functions 


^ 

Morgue  Keeper 1 

Assistant  Morgue  Keeper  (Day) 1 

Assistant  Morgue  Keeper  (Night) 1 

Clerk 1 

Hearse  Service,  Driver  (Day) 1 

Hearse  Service,  Helper  (Day) 1 

Hearse  Service,  Driver  (Night) 1 

Hearse  Service,  Helper  (Night) 1 

Boat  and  Dock  Service  (Day) 4 

Boat  and  Dock  Service  (Night) 2 

Elevator  Attendant,   Basement   to   Ground 

Floor  (Day) 1 

Elevator   Attendant   Basement   to   Ground 

Floor  (Night) 1 

Elevator  Attendant  to  Chapel  and  to  29th 

Street  Entrance 1 

Guide  to  Visitors  (Day) 1 

To  Handle  Bodies  on  Ground  Floor  (Day) . .  3 

To  Handle  Bodies  on  Ground  Floor  (Night) .  .  2 

To  Handle  Bodies  1st  Floor  ( Day) 2 

To  Handle  Bodies  1st  Floor  (Night) 1 

1 

To  Handle  Bodies  2d  Floor  (Day) 2 

To  Handle  Bodies  2d  Floor  (Night) 1 

1 

Cleaners 3 

Totals 34 


§1,050 

Sl,050 

1 

Sl,080 

Sl.OSO 

600 

600 

1 

600 

600 

600 

600 

1 

600 

600 

1,050 

1,0.50 

1 

720 

720 

720 

720 

1 

600 

600 

600 

600 

1 

480 

480 

720 

720 

1 

600 

600 

600 

600 

1 

480 

480 

600 

2,400 

1 

600 

600 

1 

480 

480 

600 

1,200 

2 

480 

960 

600 

600 

1 

480 

480 

600 

600 

1 

480 

480 

600 

600 

1 

480 

480 

720 

720 

600 

1,800 

2 

600 

1,200 

1 

360 

360 

600 

1,200 

2 

480 

960 

600 

1,200 

600 

600 

4S0 

480 

600 

1,200 

2 

480 

960 

600 

600 

480 

480 

480 

1,440 

1 

360 

360 

S21,0fi0       23 


812,480 


RATIO  OF  NURSES  TO   PATIENTS   PROPOSED   FOR 
MUNICIPAL  HOSPITALS 


THE   INVESTIGATION 

When  this  investigation  was  begun  it  was  intended  to  make  an  exam- 
ination of  the  nursing  situation  generally.  Such  an  inquiry  would  have  in- 
volved a  study  of  the  courses  now  given  in  nursing  schools  and  their  ade- 
quacy and  scope;  the  practical  work  required  of  the  pupil  nurse;  the  time 
devoted  to  such  work,  both  as  to  term  and  hours  per  day;  the  degree  to 
which  the  graduate  nurse  is  filling  the  demands  for  nursing  service;  the 
relation  of  the  physician  to  the  nurse;  and  other  phases  of  the  subject. 
Considerable  effort  was  put  forth  in  an  endeavor  to  find  an  investigator 
competent  and  free  to  undertake  this  phase  of  the  work,  but  no  such  person 
could  be  found  within  the  limit  of  time  in  which  the  investigation  could 
be  undertaken. 

The  investigation  of  the  hospitals  has  emphasized  the  necessity  for  an 
investigation  covering  the  above  phases  of  the  nursing  problem.  The 
relations  between  the  hospital  and  the  nurse,  the  public  and  the  nurse,  the 
physician  and  the  nurse,  are  in  many  regards  unsatisfactory.  Nursing 
associations  are  endeavoring  to  improve  conditions,  and  to  meet  the  demand 
for  nursing  by  educating  a  sufficient  supply  of  well  trained,  competent 
nurses.  The  supply,  however,  is  by  no  means  adequate  to  the  needs,  and 
it  is  an  open  question  whether  or  not  some  form  of  training  should  be 
offered  which  would  attract  and  equip  a  larger  number  of  women  for 
the  nursing  field;  a  form  of  training  that  would  not  encroach  upon  the 
field  of  the  highly  trained  nurse. 

It  was  found  in  this  investigation  that  the  ratio  of  nurses  employed  in 
the  different  municipal  hospitals  of  the  City  varied  greatly.  Metropolitan 
Hospital,  General  Service,  with  about  700  beds  and  8  admissions  yearly  per 
bed,  employed  i  trained  nurse  for  each  24  beds.  City  Hospital,  with  about 
800  beds  and  8  admissions  yearly  per  bed,  employed  i  trained  nurse  for 
each  42  beds.  Kings  County  Hospital,  with  about  900  beds  and  14  admis- 
sions yearly  per  bed,  employed  i  trained  nurse  for  each  21  beds.  IBellevue 
Hospital,  exclusive  of  special  services,  with  about  950  beds  and  about  24 
admissions  yearly  per  bed,  employed   i   trained  nurse   for  each    16  beds. 

No  recognized  standard  of  the  number  of  nurses  that  should  be  em- 
ployed to  a  given  number  of  beds  and  admissions  existed.  Each  hospital 
year  by  year  endeavored  to  secure  from  the  City  an  increased  number  of 
nurses,  irrespective  of  the  number  employed  by  any  other  of  the  City 
hospitals.  This  situation  resulted  in  more  or  less  rivalry  between  the 
hospitals,  each  endeavoring  to  secure  an  enlargement  of  its  nursing  force 
by  exercising  such  influence  as  it  might  upon  the  appropriating  officers  of 
the  City.  Under  these  conditions,  it  seemed  desirable  and  advisable  to 
establish  a  ratio  of  nurses  to  the  number  of  beds  and  the  number  of  ad- 
missions per  year. 

A  tentative  schedule  was  drawn  up  and  presented  to  a  number  of 
the  leading  nursing  educators  in  the  country,  and  the  conclusions  finally 
reached  are  set  forth  in  a  table  which  follows.  This  table  divides  nurses 
into  three  classes :    Supervising  Nurses ;  Head  Nurses ;  Pupil  Nurses.    The 

407 


408  HOSPITAL   COMMITTEE 

Supervising  Nurses  class  includes  all  trained  nurses  not  in  charge  of  wards. 
It  includes  those  in  charge  of  the  schools  for  nursing;  instructors;  those 
at  the  head  of  the  operating  room ;  those  in  charge  of  nurses'  homes ;  and 
those  supervising  the  work  of  head  nurses.  It  is  a  class  which  is  designed 
to  include  all  nurses  in  the  hospital  receiving  pay  higher  than  that  received 
by  head  nurses.  The  Head  Nurses  class  includes  those  in  charge  of 
wards,  and  such  other  nurses  as  may  be  doing  clerical  or  relief  work  but 
receiving  approximately  the  same  pay  as  head  nurses.  The  Pupil  Nurses 
class  includes  only  those  receiving  instruction. 

The  ratios  given  in  the  table  do  not  assume  to  provide  entirely  satis- 
factory or  adequate  service,  nor  do  they  provide  as  large  a  number  of 
mirses  as  are  provided  in  many  of  the  best  private  hospitals.  The 
finances  of  New  York  City  at  the  present  time,  however,  are  not  such  as 
to  warrant  an  attempt  to  provide  nursing  on  the  scale  provided  in  these 
private  hospitals.  The  ratios  provided  in  the  table,  though  not  as  large , 
as  they  should  be,  nevertheless  are  considerably  larger  than  at  present 
exist  in  the  municipal  hospitals,  and  are  large  enough  to  provide  a  reason- 
ably satisfactory  service.  The  table  is  not  intended  to  provide  nurses  for 
special  services,  such  as  tuberculosis,  alcoholic,  psychopathic,  out-patient, 
and  social  service. 

The  table  is  designed  to  provide  ratios  which  may  be  adapted  to  hos- 
pitals having  a  like  number  of  beds  but  varying  in  the  degree  of  acute 
service.  As  applied  to  a  hospital  of  each  specified  size,  the  first  ratio 
given  is  on  the  basis  of  lo  admissions  per  year  per  bed,  which  in  most 
cases  would  indicate  a  hospital  partly  chronic  and  partly  acute.  Provision 
is  made  for  hospitals  having  more  acute  service.  The  degree  of  acuteness 
of  service  is  measured  by  the  number  of  admissions  per  bed  per  year.  The 
general  basis  on  which  the  schedule  is  constructed  is  as  follows: 

Supervising  Nurses  in  Wards i  to  each  hospital ; 

I  additional  to  each  400  beds. 
Supervising  Nurses  in  Operating  Rooms i   to   each  hospital; 

I  additional  to  each  increase  of  15,000  admissions  yearly. 
Head  Nurses   (day)    i  to  each  30  beds ; 

I  additional  to  each  increase  of  3,000  admissions  yearly. 
Head  Nurses    (night) I  to  each  hospital ; 

I  additional  to  each  400  beds. 
Pupil  Nurses  (day) i  to  each  10  beds; 

I  additional  to  each  increase  of  500  admissions  yearly. 
Pupil  Nurses  (night) i  to  each  30  beds; 

I  additional  to  each  increase  of  3,000  admissions  yearly. 

Provision  is  also  made  for  the  supervision  of  the  nursing  school  and 
home.  The  number  of  relief  and  clerical  nurses  necessary  would  depend 
on  local  conditions.  In  the  present  schedule  the  assignment  of  these  is 
arbitrary. 

To  illustrate  by  the  schedule :  A  hospital  having  900  beds,  with  9,000 
yearly  admissions,  would  require  a  superintendent  of  the  nursing  school; 

2  instructors ;  i  supervisor  of  the  nurses'  home ;  i  supervising  nurse  for 
the  operating  room;  3  supervising  nurses  in  the  wards  (total  of  8  supervis- 
ing nurses)  ;  30  head  nurses  for  day  work;  3  head  nurses  for  night  work; 

3  relief  nurses ;  2  head  nurses  for  operating  room ;  i  head  nurse  for  clerical 
work  (total  of  39  head  or  trained  nurses)  ;  90  pupil  nurses  for  day  work; 
30  pupil  nurses  for  night  work  (total  of  120  pupil  nurses),  making  a 
complete  total  of  167  nurses.  If  the  same  hospital  should  increase  to 
18,000  admissions  yearly,  it  would  then  require  an  increase  of  i  supervising 


RATIO   OF  NURSES  409 

nurse  in  the  operating  rooms  (making  a  total  of  9  supervising  nurses)  ;  an 
increase  of  3  head  nurses  for  day  work  and  an  increase  of  i  head  nurse 
for  the  operating  room  (making  a  total  of  43  head  or  trained  nurses) ; 
an  increase  of  18  pupil  nurses  for  day  work  and  an  increase  of  3  pupil 
nurses  for  night  work  (making  a  total  of  141  pupil  nurses),  so  that  the 
complete  total  number  of  nurses  would  then  be  193. 

Should  the  hospitals  find  it  impossible  to  secure  the  number  of  pupil 
nurses  provided  for  in  the  appropriation,  it  would  seem  advisable  to  permit 
the  hospitals  to  use  the  unexpended  balance  of  such  appropriation  for  head 
nurses  and  attendants.  A  satisfactory  ratio  for  such  substitution  would 
be  I  head  nurse  and  3  attendants  for  each  10  pupil  nurses  lacking.  The 
aggregate  salary  of  the  10  pupil  nurses  would  average  about  $1,500;  the 
wages  of  those  substituted  would  be  the  same — i  head  nurse,  $600;  3  at- 
tendants at  $360  each. 

The  suggested  basis  will  be  found  on  the  following  page. 


410 


HOSPITAL   COMMITTEE 


Basis  for  Estimating  the  Number  of  Nurses  Required  in  Municipal  Hospitals 
Varying  in  Size  and  in  Proportion  of  Acute  and  Chronic  Cases  Treated. 


Supervising  Nurses 


Head  Nurses 


Pupil 
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CHILDREN'S   SERVICES 

IN    THE 

MUNICIPAL   HOSPITALS   IN  MANHATTAN  AND 
THE   BRONX 


THE   INVESTIGATION 

Nothing  usually  arouses  more  concern  in  a  family  than  the  illness  of  a 
child.  It  is  well  known  that  such  an  illness,  however  slight,  may  have  fatal 
results.  Children  lack  endurance,  and  die  apparently  from  slight  causes. 
About  one-half  of  the  mortality  is  among  those  under  fifteen  years  of 
age,  and  one-third  of  the  mortality  is  in  the  first  and  second  years  of  life. 
The  largest  mortality  is  where  there  is  the  most  sickness,  for  the  sickness 
of  children  is  chiefly  acute.  The  reduction  of  this  high  mortality  and  the 
restoration  of  the  children  to  health  is  attended  by  difficulties,  and  their 
treatment  requires  special  methods  and  facilities. 

The  premature  child,  for  instance,  requires  a  higher  degree  of  heat 
than  the  normal ;  also,  special  feeding  and  constant  attention.  Among  our 
eight  municipal  hospitals,  Bellevue  only  has  a  room  where  the  temperature 
can  be  forced  to  the  95  degrees  required  for  the  premature  child.  Only 
four  of  the  hospitals  have  attending  children's  specialists,  and  the  ratio 
of  nurses  to  children  in  the  main  ward,  except  in  Bellevue,  is  as  follows: 
Harlem  3  to  26;  Gouverneur  3  to  30;  Fordham  5  to  62  (same  nurses 
covering  both  main  and  detention  wards)  ;  Metropolitan  3  to  26;  City  3  to 
16;  etc.  The  standard  set  by  The  Babies'  Hospital  is  one  nurse  to  3 
children. 

The  great  number  of  feeding  cases  to  be  cared  for  shows  the  importance 
of  special  knowledge  and  facilities  for  feeding.  In  fact,  the  treatment 
of  all  children's  diseases  is  successful  only  where  nutrition  is  skilfully 
adjusted,  and  this  is  one  of  the  main  reasons  why  all  children  in  a  general 
hospital  should  be  attended  by  a  children's  specialist  who  is  thoroughly 
versed  in  such  matters. 

Children  seem  especially  subject  to  pneumonia,  and  this  disease  ranks 
first  in  all  the  lists  of  children's  medical  cases  admitted  during  igii. 
It  is  generally  recognized  that  abundance  of  fresh  outdoor  air  is  an 
effective  treatment,  but  in  most  of  the  hospitals,  those  children  admitted  who 
are  in  the  acute  stages  of  the  disease  are  kept  for  at  least  48  hours  in  de- 
tention rooms,  which  are  invariably  inferior  to  the  main  ward,  and  in 
these  rooms  they  frequently  suffer  from  insufficient  air.  The  pneumonia 
cases  are  often  ultimately  placed  on  the  ward  veranda,  at  least  by  day,  but 
these   verandas,   except   at  Bellevue,    are   everywhere   poorly   protected. 

Children  are  much  more  subject  to  contagion  and  infection  than  adults.  • 
Epidemics  spread  among  them  with  great  rapidity.  During  its  stay  in  a 
single  detention  room  or  general  children's  ward  a  child  may,  and  fre- 
quently does,  contract  other  diseases  than  that  with  which  it  entered. 
Provisions  for  sufficient  detention  and  isolation  rooms,  the  enforcement 
of  precautions  against  the  spreading  of  disease  by  doctors  and  nurses,  and 
the  securing  of  suitable  environment  for  the  children  in  the  main  wards 
to  which  they  are  ultimately  assigned,  have  not  been  thoroughly  carried  out 
in  any  public  hospital  in  New  York  City. 

A  well  equipped  and  well  administered  children's  service  must  always 
contend  with  the  dangers  of  loss  of  weight  and  appetite  due  to  restlessness 

413 


414  HOSPITAL  COMMITTEE 

and  worry  in  the  new  environment,  and  it  must  be  remembered  that 
a  child  needs  entertainment  and  amusement,  as  well  as  treatment. 

The  restless  little  convalescents  should  also  be  grouped  away  from 
very  sick  and  dying  children.  That  the  special  provision  needed  is 
now  made  in  but  a  very  limited  degree  is  indicated  by  the  table  on  page  23, 
which  shows  the  number  of  beds  provided  in  the  main  children's  wards; 
the  number  of  children  counted  in  such  wards  on  certain  days;  and  the 
census  shown  by  the  hospital  on  these  same  days. 

The  table  indicates  that  the  beds  provided  for  children  in  most  of  our 
hospitals  are  frequently  overcrowded.  For  instance,  in  Ward  15  of  Belle- 
vue,  having  a  capacity  of  15  beds,  on  3  days,  at  different  periods,  there 
were  17,  15,  and  18  children,  respectively.  The  main  ward  for  children 
in  Harlem  Hospital  has  a  capacity  of  26  beds.  In  the  whole  Hospital,  on 
different  days,  there  were  31  and  26  children,  respectively.  The  Hospital 
census  shows  that  there  were  17  children  in  the  main  children's  ward  during 
each  of  the  2  days.  This  indicates  that  on  the  first  day  there  were  14 
children  in  the  Hospital  in  other  wards  than  the  main  ward  assigned  to 
children,  and  on  the  second  day  there  were  9  children  distributed  in  the 
various  wards.  The  main  ward  for  children  in  Fordham  has  a  capacity 
of  42.  On  3  successive  days  there  were  in  the  whole  Hospital  39,  50, 
and  36  children,  respectively.  The  hospital  census  for  these  days  shows 
that  there  were  21,  23,  and  23  children,  respectively,  in  the  children's  ward. 
Thus,  on  the  first  day  there  were  18  children  distributed  in  the  various 
wards ;  on  the  second  day  there  were  27 ;  and  on  the  third  day  there  were 
13.  The  children's  ward  in  City  Hospital  has  a  capacity  of  16  beds. 
During  a  period  of  3  days  the  Hospital  contained  71,  72,  and  65  children, 
respectively.  The  Hospital  census  showed  that  there  were  11,  13,  and  15 
children,  respectively,  in  the  main  children's  ward.  Thus,  it  will  be  noted 
that  on  the  first  day  60  children  were  distributed  in  various  wards  other 
than  the  children's  ward;  on  the  second  day  59;  and  on  the  third  day  50. 
Since  the  above  observations  were  made  conditions  have  been  materially 
bettered  in  City  Hospital. 

One  ward  for  children  aiTords  inadequate  facilities  for  classification 
and  gives  more  excuse  for  distributing  children  through  adult  wards,  but 
children  in  adult  wards  receive  insufficient  and  inexperienced  care.  It  is 
scarcely  open  to  argument  that  the  children  in  a  hospital  should  be  cared 
for  only  by  those  experienced  in  children's  ailments,  both  physicians  and 
nurses. 

Children's  Cases  in  Some  of  the  Municipal  Hospitals  in  New  York  City 
During  the  Year  191 1 

On  subsequent  pages  tables  will  be  found  setting  forth  the  classes 
and  numbers  of  cases  cared  for  during  191 1  by  Bellevue,  Fordham,  Gouver- 
neur,  Harlem,  Metropolitan,  and  City  Hospitals.  The  first  three  tables  give 
in  detail  the  number  of  cases,  and  total  and  average  length  of  stay  accord- 
ing to  ailments.  The  cases  showing  complications  are  also  set  forth.  The 
last  table  gives  a  summary  of  the  preceding  tables,  and  indicates  more 
briefly  the  total  number  of  surgical,  medical,  and  infectious  cases  handled. 
The  information  contained  in  the  tables  was  taken  from  the  case  records  at 
each  hospital. 

An  examination  of  the  summary  table  readily  shows  the  difference 
in  the  character  of  cases  handled  by  these  institutions.     It  will  be  noticed 


CHILDREN'S  SERVICES 


415 


that  Gouverneur  and  Harlem  Hospitals  handled  within  i  of  the  same 
number  of  cases  during  the  year.  Gouverneur  cared  for  561  surgical  cases, 
as  compared  with  416  in  Harlem;  whereas,  of  medical  cases,  Gouverneur 
handled  663,  as  compared  with  798  in  Harlem.  Harlem  Hospital  seemed  to 
run  much  heavier  to  medical  cases,  and  to  have  a  much  lighter  service  in 
surgical  cases.  In  contrast  to  these  two  Hospitals  it  will  be  noticed  that 
Fordham  cared  for  794  surgical  cases  and  587  medical  cases.  In  con- 
trasting Gouverneur  with  Bellevue  Hospital,  both  being  in  downtown  sec- 
tions of  the  City,  it  will  be  seen  that  about  45  per  cent,  of  the  cases  handled 
by  Gouverneur  were  surgical,  whereas,  but  27  per  cent,  of  those  cared 
for  in  Bellevue  were  surgical  cases.  The  proportion  of  surgical  cases  in 
Metropolitan  Hospital  was  23  per  cent. ;  in  City  Hospital  26  per  cent. ;  and 
in  Fordham  Hospital  56  per  cent. 

In  reviewing  the  average  periods  of  stay  attention  is  given  only  to 
the  cases  without  complications,  as  it  would  be  impracticable  to  base  an 
average  upon  conditions  of  an  unrepresentative  character.  For  a  similar 
reason  the  cases  in  the  two  principal  services  were  grouped  in  three  classes : 
emergency,  acute,  and  long-term. 

The  emergency  surgical  cases  remained  somewhat  longer  at  the  hospitals 
of  Bellevue  Department  than  at  Bellevue  itself,  the  average  stay  in  the  re- 
spective hospitals  having  been  as  follows:  Bellevue  13  days;  Fordham  17 
days;  Gouverneur  22  days;  and  Harlem  18  days.  On  the  other  hand, 
acute  cases  remained  longer  at  Bellevue  than  at  the  others,  the  average 
length  of  stay  at  Bellevue  having  been  15  days,  as  compared  with  14  days  at 
Fordham;  12  days  at  Gouverneur;  and  11  days  at  Harlem.  So  called  long 
term  surgical  cases  remained  about  the  same  period  in  Bellevue,  Harlem, 
and  Gouverneur;  namely,  35  days  in  the  two  former,  and  37  days  in  Gou- 
verneur, whereas  in  Fordham  they  were  discharged  after  an  average  stay 
of  17  days. 

There  was  a  diflference  of  only  2  days  in  the  average  period  of  stay  of 
emergency  medical  cases  in  Bellevue  and  Allied  Hospitals;  6  days  having 
been  the  average  at  Bellevue  and  Harlem  and  4  days  at  Fordham  and 
Gouverneur.  Comparison  of  the  average  lengths  of  stay  of  acute  cases 
does  not  show  any  greater  disparity.  At  Bellevue  and  Fordham  the  average 
stay  was  12  days ;  at  Gouverneur  13  days ;  and  at  Harlem  10  days.  There 
was  not  much  difference  between  the  average  periods  of  stay  in  the  long 
term  cases  at  Bellevue,  Fordham,  and  Gouverneur;  namely,  17,  16,  and 
16  days,  respectively,  but  the  average  stay  of  13  days  at  Harlem  was  so 
markedly  shorter  as  undoubtedly  to  indicate  a  greater  pressure  upon  the 
service  at  that  Hospital. 

The  average  length  of  stay  of  acute  and  long-term  medical  cases  in 
Metropolitan  and  City  Hospitals  is  noteworthy  as  compared  with  Belle- 
vue. In  Metropolitan  the  acute  medical  remained  an  average  of  35 
days,  and  those  classed  as  long  term  91  days.  In  City  Hospital  the  acute 
cases  remained  on  an  average  of  27  days  and  the  long  term  cases  49  days. 
The  acute  and  long  term  surgical  cases  showed  a  similar  difference.  In 
Metropolitan  the  acute  class  remained  an  average  of  30  days  and  the  long 
term  51  days.  The  acute  cases  remained  on  an  average  of  31  days  in  City 
Hospital  and  the  long  term  44  days.  The  average  stay  in  these  hospitals 
seems  unnecessarily  high.  The  average  stay  was  probably  largely  increased 
by  quite  a  number  of  comparatively  well  children  who  were  allowed  to 
remain  in  the  hospitals. 

The  length  of  stay  of  infectious  cases  in  the  hospitals  is  of  interest.    In 


4i6  HOSPITAL   COMMITTEE 

Bellevue  they  remained  on  an  average  of  9  days;  in  Fordham  7  days;  in 
Harlem  9  days;  and  in  Gouverneur  17  days,  whereas,  in  Metropolitan  Hos- 
pital they  remained  57  days,  and  in  City  Hospital  54  days.  Of  the  acute 
surgical  cases  in  Fordham  Hospital,  yy  per  cent,  developed  complications, 
as  contrasted  with  23  per  cent,  in  Bellevue,  and  18  per  cent,  in  Gouverneur 
Hospital. 

The  number  of  cases  showing  complications  in  the  different  hospitals 
should  be  noticed.  Of  all  the  cases  treated  by  Bellevue,  16  per  cent,  showed 
complications ;  in  Fordham  32  per  cent. ;  Harlem  4  per  cent. ;  Gouverneur 
19  per  cent. ;  and  Metropolitan  13  per  cent.  The  records  were  not  kept  so 
as  to  show  complications  at  City  Hospital.  Fordham  Hospital  seems  to  be 
exceptionally  high  in  the  proportion  of  complications  arising  in  its  services. 

It  is  of  interest  to  observe  the  proportion  of  different  ailments  treated  in 
the  different  hospitals.  Of  wounds,  sprains,  contusions,  and  fractures,  the 
proportion  in  Bellevue  was  33  per  cent,  of  the  total  number  of  surgical 
cases;  in  Fordham  15  per  cent. ;  in  Gouverneur  31  per  cent. ;  and  in  Harlem 
31  per  cent.  It  might  be  expected  that  Gouverneur  and  Bellevue  would 
show  the  highest  percentage  of  fractures,  whereas  Harlem  Hospital  is 
slightly  higher  than  either.  On  the  other  hand,  Fordham  should  show  a 
much  less  proportion,  and  does,  according  to  the  percentages. 

Bellevue  treated  182  cases  of  broncho-pneumonia,  which  was  7  per 
cent,  of  its  total  medical  cases.  In  Fordham  6  per  cent,  of  its  medical 
cases  were  of  the  same  disease;  in  Gouverneur  21  per  cent.;  and  in  Har- 
lem 12  per  cent. 

Acute  gastro-intestinal  inflammations  in  Bellevue  constituted  6  per  cent, 
of  the  total  medical  cases ;  in  Fordham  4  per  cent. ;  in  Gouverneur  16  per 
cent. ;  and  in  Harlem  7  per  cent. 

Some  Aspects  of  the  Children's  Service  in  New  York  City  which  Require 

Attention 

There  is  a  definite  understanding  that  the  Board  of  Health  shall  care  for 
certain  contagious  diseases,  such  as  scarlet  fever,  diphtheria,  and  measles. 
There  is  also  an  understanding  that  children  with  eye  and  skin  diseases 
may  either  be  treated  by  the  Board  of  Health  clinics  or  go  to  Randall's 
Island.  It  is  customary  to  send  whooping-cough  cases  to  Randall's  Island 
or  to  Metropolitan  Hospital,  though  Metropolitan  has  onl}'  the  hospitality  of 
the  women's  medical  ward  to  offer,  and  Randall's  Island  the  one  or  more 
small,  wooden  isolation  buildings. 

Certain  classes  of  cases,  such  as  pulmonary  tuberculosis,  erysipelas, 
whooping-cough,  vaginitis,  mumps,  and  chickenpox,  are  on  a  debatable 
ground.  There  is  no  well  defined  or  adequate  provision  for  them,  and 
if  admitted  they  are  scattered  throughout  the  hospital  to  the  imminent 
danger  of  other  patients.  The  children's  service  at  Randall's  Island  is 
becoming  smaller  as  the  custodial  asylum  there  is  enlarged,  and  the  other 
hospitals  under  the  Department  of  Public  Charities  are  correspondingly 
burdened  with  cases  of  vaginitis,  eye,  and  skin  diseases. 

The  disposition  of  acute  surgical  or  medical  cases  which  develop  a 
contagious  disease  is  an  extremely  difficult  problem  to  handle.  Removal  of 
a  child  may  endanger  its  life;  nevertheless,  few  hospitals  have  isolation 
rooms  where  a  child  having,  for  example,  pneumonia  and  whooping-cough 
may,  with  safety  to  itself  and  its  neighbors,  recover  from  so  dangerous 
an  illness. 


CHILDREN'S  SERVICES  417 

The  varied  nature  of  the  service  as  set  forth  in  the  accompanying 
tables  indicates  that  a  proper  classification  would  require  quite  a  number 
of  distinct  and  separate  rooms.  The  single  detention  room  and  single 
main  ward  which  are  to  be  found  at  Harlem,  Fordham,  and  Gouverneur 
do  not  permit  of  any  real  classification,  and  Metropolitan  and  City  Hos- 
pitals- have  no  detention  rooms  which  can  be  called  such. 

Detention  Rooms 

Each  child  on  entering  a  hospital  is  kept,  when  possible,  for  ob- 
servation in  the  detention  room  for  at  least  48  hours.  Most  children's 
specialists  do  not  believe  that  this  period  is  long  enough.  But  the  inadequacy 
of  the  present  detention  rooms  makes  it  preferable  to  hurry  the  child  to 
the  main  ward,  even  though  it  may  be  dangerous  to  the  other  children  in 
that  ward. 

An  inspection  at  Harlem  Hospital  showed  that  the  detention  room 
contained  4  cribs,  making  an  allowance  of  273  cubic  feet  of  air  per  child ; 
but  the  room  frequently  holds  5  cribs.  It  is  lighted  by  a  ground  glass 
window,  and  its  single  door  opens  on  a  corridor  where  men  and  women 
are  received  from  ambulances;  doctors  and  nurses  are  constantly  passing; 
and  the  uproar  of  alcoholic  patients  is  heard.  In  this  room  all  children 
with  tuberculosis,  pneumonia,  erysipelas,  or  appendicitis  must  remain  during 
hours  of  suffering  from  disease  and  homesickness. 

In  Gouverneur  Hospital  the  single  isolation  room  opens  upon  the  same 
corridor  as  the  detention  room,  and  at  a  distance  of  only  a  few  steps. 

On  one  visit  to  this  hospital  the  investigator  saw  a  little  girl  in  the  isola- 
tion ward  tied  in  her  cot.  When  she  attempted  to  unfasten  the  knots  the 
nurse  said,  "Mamie,  you're  a  naughty  little  girl  to  run  down  the  hall." 
In  explanation  of  this  remark  the  nurse  said,  "Oh,  she  has  chickenpox, 
and  would  run  among  the  other  patients."  Within  a  few  feet  of  this  child, 
across  the  narrow  hallway,  was  a  cot  containing  a  child  with  pneumonia 
and  whooping-cough.  The  latter  case  had  been  in  the  hospital  10  days,  and 
all  children  going  to  the  main  detention  ward  had  to  pass  between  these 
two  contagious  cases,  and  all  the  cases  were  attended  by  the  same  nurse. 

City  Hospital  devotes  one  corner  of  a  women's  medical  ward  to  deten- 
tion cases,  and  at  Fordham  the  detention  ward  is  mainly  reached  by  going 
through  the  main  ward. 

Main  Children's  Wards 

The  diagnoses  of  the  children  who  laid  in  their  cots  or  played  about 
the  floor  or  verandas  in  the  main  wards  of  the  hospitals  investigated  have 
been  noted.  In  Harlem  Hospital,  on  April  9,  1912,  children  in  the  main 
ward  had  the  following  ailments :  fractured  femur ;  mastoiditis ;  tuberculo- 
sis of  knee;  abscess  of  neck;  empyema;  appendicitis;  traumatic  amputation; 
fractured  skull ;  fractured  leg ;  pneumonia  ;  pulmonary  tuberculosis  ;  paralysis 
of  lower  limbs;  marasmus;  endocarditis;  inflammation  of  middle  ear;  rup- 
tured appendix;  and,  in  addition,  six  normal  children,  whose  mothers  were 
patients,  were  in  and  about  the  ward. 

In  City  Hospital,  on  October  8,  1912,  the  list  was  as  follows:  rickets; 
pneumonia;  impetigo;  marasmus;  prolapse  of  rectum;  diphtheria  (convales- 
cent) ;  fracture  of  ulna;  eye  disease  (trachoma)  ;  ear  (running)  ;  pediculo- 
sis; superficial  infection  of  leg;  eye  case  (not  diagnosed)  ;  and  two  normal 
children,  whose  mothers  were  patients,  were  in  and  about  the  ward. 


4l8  HOSPITAL   COMMITTEE 

It  is  evident  that  the  conditions  are  not  conducive  to  the  quickest 
convalescence  of  such  varied  patients.  Surgical  cases  should  be  grouped 
by  themselves,  and  not  exposed  to  the  epidemics  which  sweep  through 
the  wards.  Contagious  cases  should  not  be  admitted  to  the  hospital,  or  at 
any  rate  to  the  children's  ward.  Recourse  should  not  be  had  to  adult 
wards  for  the  care  of  inappropriate  cases,  such  as  whooping-cough,  syphilis, 
etc.  A  tubercular  or  pneumonia  case,  which  needs  much  cool,  fresh  air, 
should  be  on  a  veranda,  while  the  marasmic,  or  premature  baby,  should 
not  only  have  abundance  of  fresh  air,  but  the  warmth  that  it  needs. 
The  child  recovering  from  an  appendicitis  operation  should  have  quiet. 
The  case  with  pulmonary  tuberculosis,  the  orthopaedic  case,  and  the  cardiac 
patient  should  go  to  a  special  hospital  or  convalescent  home,  and  the  idiot 
should  be  sent  to  an  asylum.  The  convalescents  should  be  sent  out  of  the 
hospital  as  soon  as  possible,  but,  if  retained  at  all,  they  should  at  least  have 
a  roof  ward  and  a  place  to  play.  Certainly  no  normal  children  should  be 
admitted  to  the  hospitals,  except,  perhaps,  babies  who  must  be  nursed  by 
their  mothers,  and  these  should  have  a  place  apart. 

These  self-evident  propositions  are  either  utterly  disregarded  in  most 
of  our  general  public  hospitals,  or  the  attempt  to  enforce  them  is  rendered 
ineffective  by  lack  of  facilities.  The  little  white  cots  which  look  so  safe 
and  comfortable  frequently  hold  cases  which  are  mutually  dangerous. 

Separation  of  Surgical  and  Medical  Cases 

Surgical  and  medical  cases  lie  side  by  side  and  are  equally  exposed  to 
infectious  diseases.     The  following  epidemic  conditions  were  noted: 

In  Gouverneur  Hospital,  on  March  31,  1912,  measles  appeared.  Three 
children  came  down  with  it  and  were  sent  away  by  the  Board  of  Health, 
and  the  cases  resulted  in  quarantining  the  ward,  which  was  the  third  time 
it  had  been  quarantined  during  the  winter.  At  City  Hospital  cases  of 
scarlet  fever  and  chickenpox  were  removed  from  the  ward  on  March  6, 
1913,  and  thereafter  4  children  developed  chickenpox.  On  March  9 
a  child  admitted  to  the  ward  from  the  detention  room  developed  diphtheria, 
putting  the  ward  again  in  quarantine. 

These  epidemics  greatly  reduce  the  usefulness  of  the  hospitals,  since  no 
more  children  can  be  admitted  to  the  children's  ward  until  the  quarantine  is 
lifted.    However,  new  patients  are  admitted  and  placed  in  the  adult  wards. 

Cross  Infection 

Children  undoubtedly  catch  many  diseases  from  each  other  and  remain 
in  the  hospitals  longer  than  the  original  diagnoses  would  warrant.  This 
may  be  illustrated  by  the  following  examples : 

Lena  Gedhetti  was  admitted  to  Metropolitan  Hospital  on  March  18, 
1912,  aged  I  year  and  10  months.  She  was  diagnosed  as  having  whooping- 
cough  and  assigned  to  Ward  D.  She  there  contracted  measles  from  con- 
tact with  some  other  children  who  had  been  sent  for  the  sake  of  isolation 
to  Ward  D  from  Ward  V  (girls'  and  babies'  ward).  On  March  30  she 
was  transferred  to  Ward  V,  because  there  were  other  cases  of  measles  not 
fully  developed  in  that  ward,  and  it  was  considered  that  one  more  case 
would  not  complicate  matters.  In  Ward  V  she  contracted  pneumonia,  and 
also  developed  an  abscess.  The  child  then  developed  something  which 
resembled   erysipelas  and   was   thereupon   transferred   from  Ward  V   to 


CHILDREN'S  SERVICES  419 

Ward  X,  the  female  erysipelas  isolation  ward,  where  she  was  exposed  to 
contagion  from  the  other  patients.  She  was  finally  transferred  back  to 
Ward  D.  During  her  stay  of  7  months  and  10  days  at  Metropolitan 
Hospital  she  suffered  from  whooping-cough,  measles,  pneumonia,  and  an 
abscess. 

Convalescents 

Children  in  pain  and  dying  should  not  be  in  contact  with  active  little 
convalescents.  In  one  hospital  a  lively  two-year-old  child  was  seen  shaking 
the  cot  of  another  child  sick  with  appendicitis.  On  April  4,  1912,  the 
investigator  noted  a  little  boy  in  one  of  the  wards  who  was  dying  of  kidney 
disease.  His  face  was  quite  black.  The  little  girl  in  the  next  cot  was  sit- 
ting up  and  watching  him  with  a  very  distressed  expression.  It  was  sug- 
gested by  the  investigator  that  a  screen  be  placed  around  the  cot,  but  the 
nurse  said  that  it  was  unnecessary,  and  did  not  adopt  the  suggestion. 

Happiness  helps  in  the  recovery  of  a  child.  By  the  same  rule  it  is  bad 
for  children  to  watch  other  little  patients  who  are  dying  or  in  great  pain,  as 
it  causes  them  to  have  feelings  of  fear  and  unreasoning  unhappiness  that 
may,  in  some  cases,  go  so  far  as  to  be  harmful  physically,  and  most  cer- 
tainly is  harmful  psychologically. 

In  the  adult  wards  these  influences  are  very  marked.  In  the  winter  of 
1911  a  boy  of  13,  during  his  convalescence  from  pneumonia,  sat  in  a  chair 
by  his  bed  many  days  between  men  with  delirium  tremens.  Another  boy 
whose  leg  was  done  up  in  a  splint,  and  who  was  suffering  from  a  laceration, 
was  detailed  by  a  nurse  to  help  hold  in  bed  a  man  insane  from  a  blow  on  the 
head,  and  who  was  offensive  in  every  way.  The  man  was  revolting  to 
watch  and  difficult  to  handle. 

Normal  Children 

The  admission  of  normal  children  to  the  hospitals  is  an  easy  way  of 
caring  for  families  and  relieving  the  anxiety  of  a  mother  who  has  been 
admitted  to  a  hospital.  It  is,  however,  indefensible  from  the  point  of 
view  of  the  child,  who  is  exposed  to  many  diseases,  and  frequently 
contracts  them.  The  order  of  the  Commissioner  of  Charities  dated  June 
17,  1912,  provided  for  these  children,  but  it  has  been  only  partially 
carried  out.  Other  children  who  are  entirely  normal  may  also  be  found  in 
our  hospitals,  where  at  times  they  stop  for  years.  These  are  children  who 
are  without  parents,   or  whose  parents   have  drifted   away. 

An  illustration  of  such  a  case  was  found  at  City  Hospital: 

William  Collins  was  admitted  December  29,  19 10,  aged  three  years. 
His  "residence"  was  The  Catholic  Home  Bureau,  and  his  primary  disease 
was  otitis  media.  He  was  recommended  for  discharge  April  29,  191 1,  but 
was  retained  for  the  reason  that  his  ear  was  still  discharging.  On  April 
I,  1913,  the  nurse  said  that  the  doctors  had  decided  to  operate,  but  no  action 
had  been  taken,  and  the  child  was  still  at  the  hospital. 

Another  case  was  that  of  a  forlorn  child  named  Frederick  Mann,  a 
little  colored  boy  aged  four  years,  whose  affliction  was  diagnosed  as  syphilis. 
He  was  assigned  to  Ward  V  in  Metropolitan  Hospital  onjanuary  18,  1910, 
and  was  transferred  to  Willard  Parker  Hospital  on  June  3,  1912,  infected 
with  scarlet  fever.  He  was  readmitted  to  Metropolitan  Hospital  on  July 
25,  1912,  and  his  card  read,  "No  residence,  no  disease,  no  friend,  no 
parents."    He  was  at  last  recommended  for  discharge  in  March,  19 13. 


420  HOSPITAL   COMMITTEE 

Only  great  vigilance  on  the  part  of  the  visiting  physicians,  superin- 
tendents, and  social  service  nurses  can  prevent  such  misuse  of  the  wards. 
Dr.  Bacon,  Superintendent  of  City  Hospital,  while  serving  as  Superin- 
tendent of  Metropolitan  Hospital  during  March,  1913,  discharged  22 
children  who  were  normal,  but  who,  for  lack  of  reexamination,  had  been 
permitted  to  remain  in  the  wards. 

Tonsil  and  Adenoid  Cases 

Cases  have  been  admitted  for  operation  at  all  the  hospitals  studied,  but 
in  no  instance  has  any  suitable  provision  been  made  for  them.  In  one 
hospital  patients  waited  12  hours  in  a  diet  kitchen  without  food,  and  were 
then  given  an  anaesthetic  and  operated  on  in  the  Dispensary.  When  such 
children  were  kept  all  night  they  were  placed  in  the  accident  ward.  In 
another  hospital  tonsil  and  adenoid  cases  were  kept  in  the  observation 
room  with  all  other  cases.     The  following  cases  will  illustrate  this  point: 

In  Gouverneur  Hospital,  on  June  10,  1912,  8  tonsil  and  adenoid  cases 
were  exposed  to  chickenpox  and  to  vaginitis.  (There  were  4  cases  of 
chickenpox  in  the  isolation  room  nearby  and  2  vaginitis  cases  in  the  hall.) 
In  addition,  these  cases  were  exposed  to  meningitis  and  bronchitis  to  the 
extent  of  being  in  the  same  small  room  with  cases  of  these  ailments.  In  the 
same  hospital,  on  June  25,  8  tonsil  and  adenoid  cases  in  the  observation 
ward  were  exposed  to  vaginitis  from  the  isolation  room  adjoining,  and  also 
to  contagion  from  cases  of  suspected  measles,  suspected  whooping-cough, 
and  acute  erysipelas,  held  in  beds  in  the  hall.  Cases  of  pneumonia  and 
meningitis  were  in  the  ward  with  the  tonsil  and  adenoid  cases,  and  all  the 
children  were  cared  for  by  the  same  nurse. 

Since  this  inquiry  began  an  effort  has  been  made  to  limit  the  number  of 
tonsil  and  adenoid  cases  admitted,  and  to  provide  beds  in  a  small,  separate 
ward  where  they  can  be  retained  in  case  of  secondary  hemorrhage. 

Auxiliary  Rooms 

Auxiliary  rooms  are  needed,  especially  a  recovery  room  wherein  children 
can  be  placed  until  they  are  well  out  of  ether.  There  is  no  such  room 
attached  to  most  of  our  children's  wards,  and  the  moans  of  their  fellow 
sufferers  distress  the  children  very  much.  A  room  for  dressings  should 
adjoin  both  medical  and  surgical  divisions.  Not  infrequently  a  group  of 
children  may  be  seen  holding  hands,  awaiting  their  turn  with  growing 
terror.  Small  rooms  for  observation  and  quiet  should  be  provided,  and 
a  temperature  room  also  is  greatly  needed.  If  semi-glass  partitions  be  used 
additional    rooms   need   not    greatly   increase   the   nursing    service. 

The  toilets  should  be  adapted  to  children,  and  capable  of  isolation. 
This  is  not  the  case  in  any  of  our  hospitals.  In  City  Hospital  the  children 
in  the  main  ward  share  a  bathroom  with  epileptic  women,  with  resultant 
discomfort,  in  spite  of  unceasing  vigilance  on  the  part  of  the  management. 
In  Metropolitan  Hospital  the  toilet  connected  with  Ward  V  is  only  to  be 
reached  by  passing  the  doors  of  the  isolation  rooms,  where  contagious 
cases  are  kept.  Precautions  against  the  spread  of  vaginitis  with  such  inade- 
quate toilets  and  baths  are  of  little  avail,  especially  since  the  internes 
and  nurses  who  examine  the  smears  for  traces  of  vaginitis  are  seldom 
trained  for  such  work.  The  spread  of  vaginitis  can  only  be  prevented  by 
such  precautions  as  spray,  or,  at  least,  separate  baths  for  any  children  sus- 


CHILDREN'S  SERVICES  421 

pected  of  vaginitis ;  use  of  liquid  soap ;  cheese-cloth  or  gauze  diapers,  which 
can  be  put  in  a  paper  bag  and  burned ;  sterilized  pads ;  separate  thermome- 
ters ;  and,  most  of  all,  frequent  washing  of  the  nurses'  hands.  In  Cumber- 
land Street  Hospital  20  children  had  vaginitis  at  one  time. 

A  dining-room  for  the  convalescents  is  not  necessary  if  a  convalescent 
ward  is  provided.  The  present  custom  is  to  have  the  children  eat  in  the 
diet  kitchen,  and  in  nearly  every  case  this  is  hot  and  stuffy.  The  method 
of  serving  the  food  is  especially  important.  The  nurse  too  often  goes  away 
to  her  own  luncheon  just  when  the  children  are  fed,  and  the  scrubwoman 
who  takes  her  place  frequently  spills  food  over  pillows  and  bedclothes.  The 
rule  that  the  ward  attendants  should  not  handle  the  children  should  be  en- 
forced. The  babies'  formulse  are  usually  prepared  in  the  maternity  diet 
kitchen ;  Bellevue,  only,  has  separate  and  adequate  provision  for  this. 

Isolation  Rooms 

These  perform  the  important  function  in  a  hospital  of  caring  for 
many  of  the  children  who  are  most  dangerously  ill,  those  awaiting  removal 
by  the  Board  of  Health,  and  the  surgical  and  medical  cases  which  have 
developed  an  infection  or  a  contagion  but  who  are  too  ill  to  be  moved. 
These  small  rooms  are  usually  unworthy  of  the  name  of  isolation. 

In  Harlem  Hospital  the  room  is  located  over  the  morgue,  and  is  very 
difficult  of  administration,  owing  in  part  to  the  fact  that  all  meals  and 
supplies  have  to  be  carried  a  long  distance.  In  Fordham  Hospital  the 
room  is  in  a  basement,  with  a  northern  exposure,  near  the  examining 
physicians'  office.  On  the  day  this  room  was  inspected  every  patient  who 
entered  was  cared  for  by  the  same  nurse,  who  had  just  been  handling 
infantile  paralysis  and  chickenpox. 

At  Gouverneur  Hospital  the  single,  small  room  opens  off  the  same  corri- 
dor as  the  detention  ward.  It  is  dark  and  partly  occupied  by  a  piece  of 
machinery,  and  there  is  no  running  water. 

Proper  and  adequate  isolation  should  provide  at  least  the  following 
precautionary  devices  and  measures: 

1.  Each  room  should  have  a  gown  by  the  door  to  be  slipped  on  by  the 
nurse  on  entering. 

2.  Each  room  should  have  a  washstand,  arranged  for  the  water  to  be 
turned  on  by  elbow  pressure,  and  the  nurse  should  be  required  to  wash 
her  hands  in  running  water  with  soap  powder  before  touching  a  patient. 

3.  All  equipment,  such  as  bed  pans,  thermometers,  etc.,  should  be  in- 
dividual, to  be  used  by  patients  only,  and  kept  in  each  room. 

4.  Dishes  when  soiled  should  be  sent  back  to  the  kitchen  on  a  carrier 
and  boiled  before  being  touched  by  the  kitchen  attendants. 

Sotu:ces  of  Cases 

The  district  served  by  a  hospital  in  so  far  as  it  relates  to  children's 
cases  has  been  studied  and  the  results  are  indicated  on  the  accompany- 
ing maps.  All  the  children's  cases  treated  by  the  municipal  hospitals  in 
Manhattan  and  The  Bronx  for  the  year  191 1  were  tabulated,  and  the 
residences  of  such  cases  plotted  on  these  maps.  It  will  be  noticed  on  consult- 
ing these  maps  that  the  children's  cases  cared  for  by  Gouverneur,  Harlem, 
and  Fordham  Hospitals  were  confined  almost  exclusively  to  the  ambulance 
districts  of  these  hospitals.    The  majority  of  cases  going  to  Metropolitan 


422  HOSPITAL  COMMITTEE 

and  City  Hospitals  on  Blackwell's  Island  came  from  the  ambulance  districts 
served  by  these  hospitals.  A  portion  of  the  cases,  however,  were  scattered 
through  Manhattan.  These  scattering  cases  were  largely  transferred  to 
the  City  hospitals  from  private  hospitals.  On  the  other  hand,  it  will  be 
noticed  that  the  cases  treated  by  Bellevue  were  broadly  distributed  over  the 
entire  district  of  Manhattan  and  The  Bronx.  A  few  cases  came  from 
Brooklyn,  though  the  map  does  not  contain  the  Brooklyn  district.  By 
count,  about  50  per  cent,  of  Bellevue  cases  came  from  outside  of  its  own 
ambulance  district,  and  were  not  transferred  by  other  hospitals  but  were 
brought  to  Bellevue  by  parents,  relatives,  or  friends.  It  is  a  noteworthy 
fact  that  the  children  going  to  the  subsidiary  hospitals  of  the  Bellevue 
Department  are  almost  exclusively  confined  to  their  ambulance  districts, 
while  those  going  to  Bellevue  proper  come  from  the  entire  territory  west 
of  the  East  River.  This  situation  may  be  partly  explained  by  the  fact 
that  Bellevue  is  an  old  institution  and  well  known,  and  has  trained  a  large 
number  of  physicians  throughout  the  territory  whence  the  children  come, 
and  these  physicians  probably  recommend  that  children  be  taken  to  Bellevue. 
It  is  a  question  whether  such  recommendations  would  be  made  by  these 
physicians  unless  they  had  greater  confidence  in  the  children's  service  at 
Bellevue  than  at  the  other  hospitals,  some  one  of  which  would  probably 
be  much  nearer  to  the  home  of  the  child.  It  is  a  fact  that  the  service  in 
Bellevue  is  much  superior  to  that  in  the  other  hospitals,  owing  partly  to 
the  better  facilities  provided  in  the  new  building,  but  more  largely  to  the 
employment  of  a  resident  children's  specialist  who  devotes  his  entire  time 
to  the  care  of  the  children.  Mothers  have  probably  become  aware  that 
their  children  are  better  cared  for  in  Bellevue,  and  this  feeling  and 
knowledge  they  transmit  to  their  neighbors. 

At  least,  from  the  above  facts,  this  inference  may  be  drawn :  That  a  hos- 
pital furnishing  high  grade,  satisfactory  service  for  children  will  draw  chil- 
dren from  a  much  larger  territory  than  that  covered  by  its  ambulances,  as 
a  mother  seems  willing  to  travel  a  long  distance  to  visit  her  child  in  an 
institution  where  she  feels  it  is  well  cared  for.  If  this  inference  is  well 
founded,  the  location  of  a  children's  service  would  seem  much  less  material 
than  the  character  of  its  equipment  and  treatment.  A  children's  service  or  a 
children's  hospital  conveniently  located  in  respect  to  transportation  lines 
might  reasonably  be  expected  to  attract  cases  from  an  extensive  territory. 


-f  ■     p) 


o 


^.'l     r-)"^ 


CHILDREN'S  CASES 

In  Bellevue  and  Allied  Hospitals  and  in  the  Hospitals  of  the  Departuent  of  Public  Charities  on  Black' 
Bellevue  and  Allied  Hospitals 


■  Island  During  1911 


GOUVERKEUR 


Without  Complicatio 


Department  of  Public  Charities 


Grand  Total 


Foreign  Bodic 


tiing  '    ■ 


■ji  Concussions... 

'on  genital  Malfonnal 

Fumnculosis.. 

Celluliti 

Tumor, 

Media . . 
Mastoiditis. 
Hydrocele . 
Varicocele . . 


Abscess.  . 
Furunculi 
Cellulitis.  . 

ar,  Malignant 

ar,  Non-malignant.. 


Acute  Peritonitis. 
Clmsnic  PeritoDiti 
Chronic  Ap  pen  die 
Pyloric  Stenosis.. 
Intestinal  Obstruc 


.ion  of  Joints 
ity  o£  Joints, 

;,  T.  B 

;,  Non-T.  B. 
nd  Scalds. . . 


Deforr 
Detorr 
Club  Fo. 


^elitis,  Chro' 
/elitis,  Non- 
Osteomyelitis,  T.  B, 
T.B.  of  Joints 

Pott's  Disease 

Chronic  Arthritis.. 


30  12,372 

31  38,172 


Note. — The  word  compile 


.s  employed  throughout  has  been  used  b 


;compaoied  in  the  n 


e  secondary  diagnoses. 


CHILDREN'S   CASES 
In  Beli-evub  and  Allied  Hospitals  and  in  the  Hospitals  of  the  Department  of  Public  Charities  on  Blackwkll's  Island  During  191  i. 
Bellevue  and  Allied  Hospitals  


Department  of  Public  Charities 


Without  Complicatio 


t  Complications  With  Complications 


Metropolitan 


With  Complications  Without  Complicatio 


With  Complications 


Grand  Total 


Total 17,7 


18       5,152 
28       1,067 


55,366        3,791 


Hydrocephalus 

Paralysis  (various  forms) . . 
Muscular  Atrophy 

VEJv^lar'oi^lLI^^tl^e^rt)" '. 
Chronic  Gtistrilis  (Intcstvn, 
Chronic  Brighl's  Disease.. . 


Gonoc 


s  Infection.. 


25       2,193  138  16 

Note. — The  word  complicatio 


mploycd  throughout  has  been  used  t 


In  Bellevue  / 


CHILDREN'S  CASES 
HE  Hospitals  of  the  Department  of  Pui 
I  Hospitals 


^  Black  well's  Island  During  1911 


Departuent  c 


>  Diseases. 

A.  Now  provided  for  by  City: 
Whooping-cough  (20  beds,  RS) 

B.  Now  provided  for  by  Bd.  of  Health: 

Smallpoi 

Scarlet  Fever 

Diphtheria 

Measles 

Total 

C.  Not  now  provided  for: 

Typhus  Fever,  BriD's  Disease 

Chickenpox 

German  Measles 

Mumps 

Acute  Poliomyelitis 

Cerebro -spinal  Meningitis 

Trachoma 

Ringwonn 

Scabies 

Impetigo,  Contagious 

Erysipelais 

Total 

Defects  op  Mental  Development. 
IdioU: 

(a)   Cretinism 

Imbeciles 

Feeble-minded 

Total 


s  employed  throughout  has 


diagnosis  was  accompanied  in  the  records  by  o 


Long  Term . . 


Long  Ter 


Summary 
CHILDREN'S  CASES 
z  Hospitals  of  tab  Departiient  or  Public  Charities  on  Blackwell's  Island  Dui 
iVUE  AND  Allied  Hospitals  DEPART&iKN 

lAU  GOUVERNEUR  HaRLEM 


i-  Public  Charities 


555  43  13  782  45  17  437  20  22  794  44  IS  25  G  4  S2  7  12       2,675 

vith  complications ||2  15  19  84  ^^6  14  7  ^^  11        ^    3G  ^J  12     .  ^^^^.      . . .  .^^     . . .  .^^     -  .^-^^  -      -.-.^^     .....      ^^^^^^ 


13   0,659 

671 

10 

10  329 

1,045 

IG   1,402 

109 

13 

-pith  comolications  170  6  28     23  2  12     uu 

^  17.789        1.4B2  12        5.152  425  12        5.94G  402  13        0.659  671  10      10,329  297  35        4,363  1S3  27      50,733 

91        Vn         "56  49      37^849 


,  Dhvelopuent.  . 


3,811 

150 

25 

'259 

10 

26 

'440 

26 

17 

'  29 

2 

14 

1,623 

20 

81 

6;i62 

'2O8 

30 

38,184 

2,632 

15 

7,700 

687 

13 

8,840 

663 

13 

8,270 

79S 

10 

29,238 

532 

55 

7,580 

239 

32 

99,824 

6,461 

IS 

3,076 

334 

9 

229 
13 

31 
2 

6 

463 

1 

17 

340 

39 

9 

4,272 
705 

13 

M 

690 

..." 

54 

8,970 
2,051 

518 
103 

17 
20 

4,351 

419 

10 

242 

33 

7 

464 

29 

26 

397 

41 

10 

4,977 

88 

57 

590 

11 

54 

11,021 

621 

18 

200 
146 

7 

21 

...." 

....' 

....' 

12 

! 

12 

3 

....* 

....!' 

...."' 

3 

20 

148 

8 

19 

employed  througliout  has  been  used  t 


CHILDREN'S  SERVICES 


423 


Accommodations  for  Children  in  Some  of  the  New  York  Municipal  Hospitals,  and 
Findings  in  Regard  to  Same  During  Visits  in  1913. 

TABLE  I. 


Name  of 
Hospital 


■n         >.  -D  J  r>       --J- .  Census  on  2  or  More      Main  Children's 

Present  Bed  Capacity     ^^^^^^       Visits  at  Intervals       Ward  Census  on 


of  Wards 


1911 


of  1  Week  or  More 


Same  Days 


Note. — Bellevue 
has  many  chil- 
dren's wards 
and  therefore  is 
not  typical. 


21,  23,  23 


Bellevue. 


4  Medical  Wards. 


46     4,229 

30 

31 

10 


Pordham. 


115 
14 
17 
gj 

Main 42     1,388 

Detention 20 

Isolation 3 

Adult 6 

Beds  for  babies  as  re- 
quired in  Maternity 
Convalescent  Dining- 
room. 


31,  44,  34 
21,  22,  28 
34,  29,  23 
10,     5,     6 

17,  15,  18 

14,  16,  18 

15,  18,  18 
7,     6,     7 

39,  50,  36 


31,  26 


Harlem.            Main 26      1,100 

Detention 4-5 

Isolation 4 

Adult 2-12 

Beds  in  Maternity  Ward 
as  required. 

Gouvemeur.     Main 30     1,182             29,  28,  31 

Detention 10 

Isolation 3 

Adult 2 

Cribs  and  beds  in  Ma- 
ternity Ward  as  re- 
quired. 

Metropolitan.  Medical:   Girls 26        679             16,15 

"           Boys 26 

Surgical:  Beds  in 
Adult  Wards  as 
required. 
Whooping-cough  and 
chickenpox  in  Wo- 
men's Medical.  .  .  8 

Vaginitis 8 

Orthopedic  and  Tu- 
berculosis: 

Boys 37 

Girls 16                          28 

City  Hospital.  Main  Ward 16        326             71,  72,  65 


17,  17 


28,  28,  31 


'11,  21 
16,  15 


Metropolitan  is 
frequently  in 
quarantine  and 
it  is  difficult  to 
obtain  statistics. 


25,  38 
16 

11,  13,  15 


'  Children  formerly  in  Ward  12  now  attended  by  same  doctors  but  placed  in  Ward  7. 
*  There  is  no  main  children's  ward  in  Metropolitan  Hospital  and  these  figures  give 
the  census  of  the  general  wards. 


PHYSICAL    EXAMINATION    AND    EMPLOYMENT    OF 
DEPENDENTS   IN   CITY  HOMES    (ALMSHOUSES) 


FOREWORD 

BQstory  of  the  Care  of  Dependents — New  York  Cityi 

In  the  early  years  of  the  City  of  New  Amsterdam,  about  1600,  the  poor 
were  maintained  at  the  expense  and  under  the  care  of  the  Church.  The 
fund  for  their  support  was  collected  by  voluntary  contributions  made  to  the 
poor  boxes  and  distributed  by  the  officers  of  the  Church.  The  needy  were 
assisted  in  their  own  houses,  and  such  as  had  no  homes  were  provided  with 
shelter  in  a  house  hired  for  the  purpose.  This  house  for  a  long  time  was 
located  on  the  west  side  of  Broad  Street,  just  north  of  Beaver  Street.  Be- 
sides this  poorhouse  the  City  at  this  time  was  provided  with  a  hospital. 
This  hospital  was  built  in  1658,  when  the  population  of  the  City  was  about 
1,000. 

The  poor  were  assisted  in  about  the  same  manner  until  about  the  year 
1691,  when  the  Church  fund  was  increased  by  an  appropriation  from  the 
public  treasury;  this  fund  was  disbursed  by  the  Mayor  to  poor  persons 
recommended  by  the  Aldermen,  after  due  investigation  by  the  City  Con- 
stable. 

In  September,  1693,  a  poor  law  was  passed  by  the  Assembly,  providing, 
among  other  things,  for  the  appointment  and  support  of  a  good  minister  in 
each  parish  or  precinct,  and  also  for  the  maintenance  of  the  poor  by  a  rea- 
sonable tax.  In  169s  the  General  Assembly  passed  a  law  entitled,  "An 
Act  to  enable  the  City  of  New  York  to  relieve  the  poor  and  to  defray  their 
necessary  and  public  charges."  Pursuant  to  this  law  an  inspector  of  the 
poor  was  appointed,  and  100  pounds  a  year  were  appropriated  for  the  main- 
tenance and  support  of  the  poor.  By  the  end  of  the  year  the  fund  had  be- 
come entirely  inadequate  and  further  appropriation  was  made.  The  total 
for  the  year  was  156  pounds  sterling. 

During  the  winter  of  1713-14  the  distress  among  the  poor  was  very 
great.  It  was  found  by  the  Justice  and  Church-warden  that  they  were  per- 
ishing for  want  of  clothing  and  provisions,  whereupon  a  sum  of  100  pounds 
was  borrowed  by  the  City  for  their  support  for  six  months.  The  proposi- 
tion also  was  first  made  at  this  time  for  the  establishment  and  building  of  a 
poorhouse,  and  a  committee  of  six  members  of  the  Common  Council  was 
appointed  to  consider  the  matter.  The  appointment  of  the  committee,  how- 
ever, did  not  result  in  building  a  poorhouse,  and  it  was  twenty  years  be- 
fore any  decided  steps  were  taken  in  this  direction. 

According  to  the  census  of  1731  the  City  contained  1,400  houses  and 
had  a  population  of  8,628.  There  were  many  poor,  including  a  proportion- 
ately large  class  of  vagabonds  and  idle  beggars.  The  poor  were  still  boarded 
at  the  public  expense,  or  wandered  about  begging.  At  this  time,  in  1731, 
the  City  suffered  its  third  epidemic ;  smallpox  raged  with  great  fatality. 

*  The  historical  data  set  forth  was  compiled  from : 
Valentine's   Manual. 

Reports  of  the  Commissioners  of  the   Almshouse. 
Reports   of   the   Governors   of   the   Almshouse. 
Reports  of   the  Department  of   Qiarities  and   Correction. 
Reports  of  the  State  Board  of  Charities. 
427 


428  HOSPITAL   COMMITTEE 

It  became  apparent  that  some  means  must  be  devised  to  meet  these  condi- 
tions, and,  accordingly,  the  Common  Council  appointed  a  committee  to  in- 
quire as  to  where  a  house  suitable  to  be  used  as  a  workhouse  might  be  pur- 
chased. This  committee,  after  due  investigation,  reported  on  December  20, 
1734,  in  favor  of  the  erection  by  the  Corporation  of  a  workhouse.  They 
recommended  that  it  be  placed  on  uninmproved  lands  belonging  to  the  City, 
situated  on  the  north  side  of  the  lands  of  the  late  Colonel  Dongan,  com- 
monly called  the  "Vineyard."  This  recommendation  was  unanimously 
adopted  by  the  Board  and  a  committee  nominated  to  carry  out  the  measure. 
It  was  to  be  called  "Publick  Workhouse  and  House  of  Correction  of  the 
City  of  New  York."  The  site  was  the  ground  on  which  the  City  Hall  now 
stands.  The  building  was  begun  in  1735  and  was  ready  for  occupancy  early 
in  the  year  1736.  It  was  56  feet  long  and  24  feet  wide,  and  contained  two 
stories  and  a  cellar.  Within  this  small  space  were  confined  the  maniac,  the 
unruly,  the  poor,  the  aged,  and  the  infirm.  By  1746  the  building  was  out- 
grown and  required  extensive  additions  and  repairs. 

In  1776,  when  the  war  broke  out  between  England  and  the  United 
States,  the  inmates  were  transferred  to  Poughkeepsie,  there  to  remain  until 
the  close  of  the  war.  On  the  return  of  the  poor  at  the  end  of  the  war 
additional  buildings  were  erected  to  increase  the  accommodations.  After 
the  war  the  distress  in  the  City  was  exceedingly  great;  the  number  of  the 
poor  was  much  larger  than  it  had  been;  and  the  general  tax  very  burden- 
some. A  commission  was  appointed  to  investigate  the  Almshouse,^  and,  as 
a  result,  recommended  a  more  economical  management.  In  1775  the  poor 
tax  amounted  to  4,233  pounds;  this,  based  on  the  census  of  1773,  was  about 
.189  pound,  or  95  cents,  per  capita.  The  Almshouse  and  Bridewell,  lo- 
cated on  the  present  site  of  the  City  Hall,  were  at  this  time  under  the  im- 
mediate management  of  the  Mayor  and  Recorder,  in  conjunction  with  the 
Vestrymen,  the  Aldermen,  and  Assistant  Aldermen.  The  record  of  the 
census  taken  at  the  Almshouse  on  the  14th  day  of  November,  1785,  shows 
a  total  of  301,  of  whom  115  were  males. 

This  house  was  occupied  by  the  inmates  until  1796.  Two  years  before 
steps  had  been  taken  to  erect  a  new  building,  the  old  one  being  then  utterly 
unfit  and  altogether  too  small  to  meet  the  demands.  To  carry  out  this  pur- 
pose, in  January,  1794,  the  Common  Council  applied  to  the  Legislature  for 
authority  to  raise  the  sum  of  10,000  pounds  by  means  of  a  pubHc  lottery. 
This  the  Legislature  granted.  The  site  selected  on  which  to  build  was  in 
the  rear  of  the  grounds  occupied  by  the  old  Almshouse  building,  on  what  is 
now  the  south  side  of  Chambers  Street,  and  on  the  site  now  occupied  by  the 
Courthouse.  It  was  finished  in  1796,  and  the  paupers  were  removed  to  it 
on  May  20th  of  that  year.  The  number  of  inmates  at  the  time  of  the  trans- 
fer was  622,  and  only  102  of  these  were  of  native  birth.  Such  is  the  his- 
tory of  the  Almshouse  down  to  181 1. 

From  1794  to  1805  there  occurred  yearly  epidemics  of  yellow  fever, 
causing  a  considerable  increase  of  poor  and  destitute.  The  Almshouse  had 
become  altogether  too  small,  and  in  181 1  a  special  meeting  of  the  Common 
Council  was  called  to  consider  an  offer  which  had  been  received  from  the 
heirs  of  the  Kip  family  to  sell  a  part  of  the  old  Kip's  Bay  Farm,  located  at 

*  The  records  are  not  clear  as  to  the  official  titles  of  the  City's  early  institu- 
tions, but  inasmuch  as  the  reference  to  Commissioners  of  the  Almshouse  in  1816 
requires  the  capitalization  of  the  name  of  that  institution  subsequent  to  the  first 
mention  of  it,  the  same  form  has  been  followed  in  the  designation  of  the  others. — 
Editor. 


EMPLOYMENT   OF  INMATES  429 

the  foot  of  26th  Street  and  East  River.  A  committee  was  appointed  at  this 
meeting  to  purchase  the  site  at  a  price  not  exceeding  $3,500  an  acre.  The 
bargain  was  made  a  few  days  later  on  this  basis.  The  survey  showed  that 
the  plot  contained  over  6  acres,  and  that  it  was  bounded  northerly  by  Belle 
Vue  Place,  which  already  belonged  to  the  Corporation  in  fee  simple,  and 
whereon  there  already  stood  the  first  building  which  was  to  bear  the  name, 
Bellevue  Hospital.  The  corner-stone  of  the  new  Almshouse  building  was 
laid  on  July  29,  181 1,  and  on  April  22,  1816,  the  building  was  ready  for 
occupancy.  The  buildings  comprising  the  new  Bellevue  establishment  were 
two  hospital  pavilions,  the  Almshouse  itself,  one  workshop  or  factory  de- 
signed as  the  Penitentiary,  and  a  school.  To  the  southward  of  the  Alms- 
house stood  the  home  of  the  Superintendent  of  the  establishment,  who  was 
also  one  of  the  Commissioners  of  the  Almshouse.  The  total  cost  complete, 
as  reported  to  the  Common  Council  on  February  9,  1818,  was  $421,109.56. 

In  March,  181 7,  there  were  more  than  200  patients  in  the  Hospital. 
The  number  of  paupers  supported  in  the  Almshouse  varied  in  different  sea- 
sons of  the  year,  but  in  round  numbers  there  were  between  1,600  and  2,000. 
Notwithstanding  the  very  large  service  of  these  institutions,  the  City  was 
at  this  time  confronted  with  an  extremely  grave  problem;  viz.,  the  care 
of  the  alien  poor. 

Beginning  with  the  eighteenth  century  there  commenced  an  extensive 
immigration  from  Ireland.  The  immigrants  were  of  the  poorest  and  most 
destitute  class,  and  so  great  was  the  poverty  of  these  early  immigrants 
that  they  were  willing  to  sell  themselves  into  peonage  for  the  sum  of  ten 
pounds.  The  last  sales  of  immigrants  were  reported  in  1819  in  Phila- 
delphia. 

In  the  Second  Annual  Report  of  the  Managers  of  the  Society  for  the 
Prevention  of  Pauperism  in  the  City  of  New  York,  1819,  are  the  following 
statements : 

Through  this  inlet,  pauperism  threatens  us  with  the  most  overwhelming  con- 
sequences. .  .  .  The  present  state  of  Europe  contributes  in  a  thousand  ways  to 
foster  unceasing  immigration  to  the  United  States.  .  .  .  An  almost  innumerable 
population  beyond  the  ocean  is  out  of  employment.  .  .  .  This  country  is  the 
resort  of  vast  numbers  of  these  needy  and  wretched  beings.  .  .  .  They  are 
frequently  found  destitute  in  our  streets ;  they  seek  employment  at  our  doors ; 
they  are  found  at  the  bar  of  our  criminal  tribunals,  in  our  Bridwell,  our  Peniten- 
tiary, and  our  State  Prison,  and  we  lament  to  say  that  they  are  too  often  led  by 
want,  by  vice,  and  by  habit  to  form  a  phalanx  of  plunder  and  depredation,  render- 
ing our  City  more  liable  to  increase  of  crimes,  and  our  houses  of  correction  more 
crowded  with  convicts  and  felons. 

The  condition  above  cited,  coupled  with  an  epidemic  of  yellow  fever  in 
1819,  caused  a  marked  increase  of  persons  applying  for  relief.  It  became 
necessary  to  build  a  hospital  for  contagious  diseases,  and  such  a  hospital 
was  built  at  Fort  Stevens,  on  the  Long  Island  shore,  at  Hallit's  Point.  This 
hospital  was  under  the  charge  of  the  Bellevue  physicians.  Three  years  later 
another  hospital  for  contagious  diseases  was  built  at  Bellevue. 

By  1826,  following  the  suggestion  of  the  Medical  Committee  of  Investi- 
gation, of  the  previous  year,  the  Common  Council  endeavored  to  find  a  place 
to  which  the  prison  might  be  removed.  In  1828  Blackwell's  Island  was 
bought  and  a  new  Penitentiary  building  was  begun,  but  not  until  1836  was 
it  ready  for  the  reception  of  inmates,  who,  in  the  meantime,  had  been  kept 
at  Bellevue.  The  men  were  transferred  first,  but  the  women  remained  two 
years  more,  until  the  Tombs  was  ready  to  receive  them. 


430  HOSPITAL    COMMITTEE 

During  this  period  the  conditions  at  Bellevue  were  far  from  ideal,  as 
appears  from  the  following  communication  of  the  Superintendent  of  the 
Almshouse  to  the  Secretary  of  State,  dated  January  7,  1833 : 

I  received  yours  of  the  2Sth  ult.,  with  some  blanks  and  the  poor  laws.  I 
have  delayed  answering  your  communication,  waiting  for  information  relative 
to  licenses. 

The  annual  return  from  the  Almshouse,  I  believe,  was  mailed  the  same  date 
as  yours,  which  I  hope  you  received;  there  are  no  printed  documents  relative  to 
the  poor  in  the  City  of  New  York. 

I  have  obtained  a  copy  of  the  last  annual  report  of  the  Comptroller  which  I 
send  you. 

From  what  experience  I  have  had  as  Superintendent  of  the  Poor  for  nearly 
two  years,  I  have  no  hesitation  in  saying  that  the  present  system  might  be  much 
improved.  The  number  of  male  adults  at  present  in  the  Almshouse  is  572,  out  of 
which  number  there  are  not  10  who  can  be  called  sober.  The  number  of  female 
adults  is  601,  and  I  doubt  whether  there  are  50  of  them  who  can  be  called  sober 
women. 

I  consider  the  present  poor  law  as  calculated  to  encourage  intemperance  from 
the  fact  that  the  moment  they  become  habitual  drunkards  the  public  provides  an 
asylum  for  them,  at  which  they  remain  during  their  pleasure.  When  they  are 
ordered  at  work  many  of  them  take  their  discharge.  They  soon  become  miserable 
objects  about  our  streets  and  are  sent  again  to  the  Almshouse,  and  by  the  time 
they   get   well,   take   their   discharge,   and   so  on,   from   year  to  year. 

I  believe  that  all  persons  whom  the  public  support  as  habitual  drunkards  ought 
to  be  committed  to  a  workhouse  for  at  least  12  months,  where  they  could  be  com- 
pelled to  earn  their  living.  When  their  time  expires,  if  they  take  their  discharge 
and  again  become  intemperate,  commit  them  again  for  12  months,  and  so  continue. 

I  send  you  a  weekly  return  of  our  Almshouse,  ending  on  the  5th  inst.,  by 
which  you  will  perceive  we  have  1,852  paupers,  1,017  of  whom  are  natives  (this 
last  number  includes  all  the  children  born  of  foreign  parents),  835  foreigners, 
who  travel  here  from  all  parts  of  the  United  States.  There  can  be  no  doubt 
that  the  Almshouse  originally  vi'as  intended  for  old  respectable  poor ;  but  as  at 
the  present  organized,  it  has  become  an  asylum  for  thieves,  prostitutes,  and  the 
worst   of   the   human   family. 

The  police  magistrates,  by  the  present  law,  have  the  power  to  commit  vagrants 
to  the  Almshouse,  and  in  the  exercise  of  that  power  they  commit  men  and  women 
who  have  in  some  cases  been  discharged  from  the  penitentiary  but  a  few  days,  and 
in  some  others,  on  the  same  day.  The  police,  in  my  judgment,  ought  not  to  have 
control  of  the  inmates  of  the  Almshouse.  They  have  in  many  instances  committed 
persons  for  six  months  who  were  not  residents  of  the  County,  and  in  some,  where 
they  were  not   residents  of  the   State. 

As  early  as  1830  a  Special  Committee  on  Pauperism  was  appointed  to 
study  the  condition  of  the  poor,  and  also  to  find  a  suitable  site  for  a  poor 
farm  in  connection  with  the  Almshouse.  On  May  31,  1830,  the  Committee 
rendered  its  report,  recommending  the  purchase  of  Great  Barn  Island  (now 
called  Ward's  Island),  but  at  the  same  time  stating  the  following: 

There  are  other  locations  to  be  had  which  may  answer  as  well  as  Barn 
Island,  and  your  Committee  trust  that  the  Board  will  not  consider  the  project 
for  a  "poor  farm"  less  likely  to  be  successful  because  that  special  location  cannot 
be  procured  at  a  reasonable  price,  and  they  would  therefore  invite  your  attention 
more  especially  to  the  system  proposed,  and  would  have  the  inquiry  made  whether 
Blackwell's  Island  cannot  be  cultivated  upon  a  plan,  which  would  give  profitable 
employment  to  some  of  our  paupers,  and  whether  the  lands  now  attached  to  the 
Almshouse  (Bellevue  Establishment)  may  not  be  more  advantageously  worked 
by  them  than  they  are  now. 

The  consideration  of  the  Board  would  be  well  directed  in  viewing  the  great 
advantages  which  may  result  to  our  Insane  Establishment  by  the  use  of  the 
extensive  grounds. 

The  Board  are  aware  that  this  peculiarly  interesting  and  afflicted  portion  of 
our  poor  family  are  now  inhabiting  a  part  of  the  building  nick-named  "the  fever 
hospital,"  where  they  are  but  poorly  accommodated,  and  where  their  shrieks  and 
agonizing  noises  are  adding  to  the  pains  of  those  sick  and  dying  poor  who  occupy 


EMPLOYMENT   OF   INMATES  43 1 

the  greater  part  of  the  same  building.  Now  if  this  City  possessed  a  large  farm, 
these  lunatics  could  be  separated  from  the  present  hospital  establishment,  when,  if 
they  had  a  building  properly  arranged  for  the  classification  of  patients,  and  an 
occasional  opportunity  was  allowed  to  such  as  may  be  fit  subjects  to  indulge  in 
tilling  the  earth,  they  would  be  much  better  off. 

But  the  idea  of  establishing  a  poor  farm  was  not  carried  out,  and  by 
1837  the  condition  of  the  Almshouse,  Lunatic  Asylum,  and  Hospital  was 
bad  enough  to  shock  the  sensibilities  of  the  Common  Council  and  moved 
them  to  investigate  it.  The  report  of  the  Common  Council  conveys  a  vivid 
idea  of  the  state  of  things. 

In  the  Almshouse  itself  the  female  part  was  found  in  good  order, 
furnishing  a  "silent  rebuke  to  the  contrast"  in  the  other  parts  of  the  build- 
ing. The  adult  males  were  in  a  filthy  and  ragged  condition ;  the  sick  were 
in  every  part  of  the  house;  and,  with  the  above  exception,  the  whole  de- 
partment exhibited — to  further  quote: 

evidence  of  neglect  of  the  public  interest  and  want  of  a  proper  regard  to  the 
subjects  of  misfortune.  Complaints  of  poor  and  scant  provisions,  and  unavailing 
application  for  relief  were  numerous  and  voluntary.  Many  were  without  shirts, 
and  destitute  of  sheets  and  blankets,  and  such  bedding  as  there  was,  was  not 
clean.  The  building  assigned  to  colored  subjects  was  an  exhibition  of  misery 
never  witnessed  by  your  Commissioners  in  any  public  receptacle  for  even  the  most 
abandoned  dregs  of  human  society.  Here  were  scenes  of  neglect  and  filth,  of  putre- 
faction and  vermin.  Of  system  of  subordination,  there  was  none.  The  same  ap- 
parel and  the  same  bedding  had  been  alternately  used  by  the  sick  and  dying, 
the  convalescent,  and  those  in  health,  and  that  for  a  long  period.  The  situation  in 
one  room  was  such  as  would  have  created  contagion  as  the  warm  season  came  on, 
the  air  seeming  to  carry  poison  with  every  breath. 

In  the  Hospital  were  265  patients,  over  one-half  of  whom  were  insane. 
The  commissioners  stated  at  the  outset  that  they  "will  not  enter  into  all 
the  details  of  disgusting  particulars  witnessed  in  the  Hospital.  The  con- 
dition of  Bellevue  Hospital  was  such  as  to  excite  feelings  of  the  most 
poignant  sympathy  for  its  neglected  inmates."  The  building,  from  cellar  to 
garret,  abounded  in  filth;  the  lack  of  proper  ventilation  deprived  the 
wretched  inmates  of  even  the  free  gift  of  fresh  air.  Wards  had  not  been 
whitewashed  for  two  years,  and  the  Hospital  generally  was  in  a  condition 
manifesting  great  neglect  and  indifference  toward  its  inmates.  At  this  time 
jail  fever  appeared  among  the  prisoners,  and  some  cases  occurred  in  the 
Almshouse.  Many  cases  of  the  disease  had  been  admitted  to  the  Hospital 
and  filled  it  to  overflowing. 

The  Bellevue  institution  had,  from  time  to  time,  got  rid  of  various 
classes  other  than  the  sick.  The  first  to  be  taken  in  this  elimination  process 
were  the  male  prisoners,  who  went  to  the  new  Penitentiary  building  on 
Blackwell's  Island,  in  1836.  They  were  followed  in  1837  by  the  smallpox 
patients,  who  were  taken  to  a  small  wooden  building  erected  on  the  end  of 
the  island.  The  following  year  the  female  prisoners  were  sent  to  the 
Tombs,  as  has  already  been  mentioned,  and  on  June  10,  1839,  the  lunatics 
were  removed  to  the  new  asylum  on  Blackwell's  Island.  The  only  institu- 
tion left  was  the  Almshouse. 

On  October  5,  1842,  the  Commissioners  of  the  Almshouse  addressed  a 
communication  to  the  Board  of  Aldermen  in  which  they  asked  the  attention 
of  the  Board  to  the  very  urgent  call  for  enlarged  accommodations  in  cer- 
tain parts  of  the  establishment  under  their  charge.  Their  reasons  were 
stated  as  follows: 


432  HOSPITAL   COMMITTEE 

The  great  increase  in  the  number  of  applicants  for  the  public  bounties,  and 
the  alarming  additions  to  the  list  of  inmates  in  the  Penitentiary  require  the  most 
serious  consideration.  The  present  accommodations  for  both  paupers  and  criminals 
are  insufficient.  Great  as  has  been  the  recent  increase  of  paupers,  it  is  less  in  pro- 
portion than  that  of  prisoners. 

There  were  committed  to  the  Penitentiary  in  August,  1842,  21S  females,  by  the 
Magistrate,  as  vagrants ;  and  in  like  manner,  of  the  128  in  September,  1842,  120 
were  vagrants.  The  Penitentiary  suffered  from  an  overcrowded  condition.  The 
inconvenience  was  mostly  felt  in  the  want  of  accommodation  in  the  Female  Hospital. 
The  poor,  wretched  inmates  of  this  building  were  crowded  together,  thus  impeding 
the  chance  of  recovery  and  exciting  the  most  serious  apprehension  of  Prison  or 
Typhus  Fever. 

The  want  of  room  in  many  cases  had  rendered  it  necessary  to  place  three 
patients  in  two  cots. 

The  Commissioners  further  recommended  the  building  of  a  workhouse 
and  almshouse  on  Blackvvell's  Island.  This  communication  was  referred 
to  the  Committee  on  Charity  and  Almshouse,  but  no  action  was  taken.  A 
few  months  later  when  the  Commissioners  rendered  their  annual  report 
they  again  urged  the  necessity  of  erecting  an  almshouse  and  workhovise  on 
Blackwell's  Island.    The  workhouse,  they  stated : 

Would  be  an  establishment  intermediary  in  its  character  between  the  Alms- 
house and  Penitentiary,  to  which  idlers  and  vagrants,  and  able-bodied  drones  may 
be  committed  and  industrially  employed,  which  may  not  partake  of  the  degradation 
or  reproach  of  a  commitment  to  the  Penitentiary,  while  it  may  work  the  penitential 
reform  which  that  institution  has  failed  to  effect.  A  workhouse  establishment  for 
this  purpose  would  be  an  institution  for  the  punishment  of  idleness  rather  than 
-  crime.  It  would  be,  if  properly  conducted,  a  most  efficient  and  powerful  agent 
in  checking  the  progress  of  vice,  by  arresting  it  in  its  incipient  stage,  ere  idleness 
ripened  into   crime. 

After  many  difficulties  a  Special  Committee  on  the  Reorganization  of  the 
Almshouse  was  appointed,  which  Committee,  on  March  6,  1843,  passed  a 
resolution  providing  for  the  erection  of  an  almshouse  proper;  an  adult  and 
a  children's  hospital ;  an  extension  of  the  Lunatic  Asylum ;  a  workhouse  on 
Blackwell's  Island ;  and  nurseries  and  an  infants'  hospital  on  Randall's 
Island.  On  May  8,  1843,  the  Commissioners  of  the  Almshouse  and  Bride- 
well sent  in  their  report  to  the  Board  of  Aldermen,  with  plans  for  the 
buildings.  It  was  not  until  1848,  however,  that  Bellevue  got  rid  of  its  last 
attachment — the  Almshouse. 

On  April  6,  1849,  an  act  was  passed  by  the  State  Legislature  abolishing 
the  office  of  Commissioners  of  the  Almshouse  and  in  place  thereof  creating 
the  Almshouse  Departinent  of  the  City  and  County  of  New  York,  including 
therein  the  Almshouse  proper,  for  the  support  and  relief  of  the  poor;  the 
County  Lunatic  Asylum ;  the  Nurseries,  for  poor  and  destitute  children ;  the 
Penitentiary ;  the  City  Prison  and  Bridewell ;  and  the  other  prisons  and 
houses  of  detention  in  the  City,  with  the  hospital  connected  therewith. 
The  act  also  provided  that  all  these  institutions  were  to  be  under  the  con- 
trol and  management  of  a  board  of  governors,  to  consist  of  ten  persons,  to 
be  named  and  styled  "The  Governors  of  the  Almshouse." 

The  Board  of  Governors  went  earnestly  to  work,  giving  their  earliest 
attention  to  Bellevue  Hospital.  They  carefully  examined  into  the  princi- 
ples of  management  of  similar  institutions,  both  in  this  countrj'  and  abroad, 
and  took  counsel  of  eminent  medical  men  in  the  City,  as  well  as  of  the 
members  of  the  Medical  Board  themselves,  and,  after  thus  inquiring  into 
the  reasons  for  and  against,  they  determined  upon  a  radical  change  in  the 
medical  management.     The  entire  hospital  was  placed  under  the  supervi- 


EMPLOYMENT   OF  INMATES  433 

sion  of  a  non-professional  warden,  on  October  i,  1849.  New  rules  and 
regulations  were  adopted,  and  the  house  staff  reorganized. 

In  1850  the  City  expended  for  prisons  and  public  paupers  the  sum  of 
$421,882,  and  for  paupers  in  private  institutions  the  sum  of  $9,863,  making  a 
total  of  $431,745.  This  was  the  beginning  of  subsidizing  private  institu- 
tions for  the  care  of  dependents. 

In  1861  the  new  Island  Hospital  (now  City  Hospital)  was  opened,  and 
a  large  number  of  chronic  cases  were  transferred  from  Bellevue  to  that 
hospital.  The  following  appears  in  the  report  of  the  Warden  of  Bellevue 
to  the  Department  of  Charities  and  Correction,  dated  January  i,  1861 : 

The  determined  effort  to  keep  the  Institution  (meaning  Bellevue)  as  free 
as  possible  from  persons  who  were  not  fit  subjects  for  hospital  treatment  has 
had  a  very  beneficial  effect;  for,  while  we  have  not  had  many  more  patients  in 
the  Hospital  at  any  time  this  year  than  last,  there  were  treated  and  relieved  here 
this  year  over  thirteen  hundred  patients  more  than  the  year  previous.  The  same 
system  will  have  to  be  continued,  as  want  of  employment  this  season  is  certain  to 
produce  destitution  and  sickness. 

A  few  years  passed  without  any  important  changes.  In  1867,  however, 
by  the  demolition  of  the  New  York  Hospital,  supported  by  a  private  char- 
itable organization,  the  City  was  deprived  of  hospital  accommodation  below 
Twenty-sixth  Street,  the  small  Emergency  Hospital  having  been  built  on 
Twenty-sixth  Street  a  short  time  prior  thereto.  The  area  south  of  that 
street  comprised  six  square  miles,  and  contained  a  resident  population  of 
300,000  persons;  but  through  the  business  hours  of  the  day  the  popula- 
tion, gathered  from  all  parts  of  the  City  and  the  adjacent  country,  was 
much  larger  than  this  number,  and  in  this  crowded  and  busy  portion  of  the 
City  the  largest  number  of  casualties  occurred.  To  atone  for  the  great 
public  loss  by  the  destruction  of  the  New  York  Hospital  the  Legislature  of 
1868  directed  the  Commissioners  to  provide  a  Reception  Hospital  south  of 
Grand  Street;  but  because  of  an  error  in  the  language  of  the  act  the  law 
was  inoperative.  The  Legislature  of  1869  corrected  the  error,  and  the 
Commissioners  endeavored  to  find  a  suitable  site,  but  were  unsuccessful 
until  the  Commissioners  of  Public  Parks  assigned  them  the  temporary  use 
of  a  building  in  the  City  Hall  park.  In  December,  1870,  another  Reception 
Hospital  was  opened  at  99th  Street. 

The  use  of  the  City  park  building  was  indeed  temporary,  for  shortly 
thereafter  the  building  was  condemned  by  the  Tenement  House  Depart- 
ment and  torn  down,  and  this  section  of  the  City  again  remained  without 
proper  hospital  accommodation.  In  the  annual  report  of  the  Department 
of  Public  Charities  and  Correction  for  1883  the  Commissioners  urged  the 
immediate  necessity  of  building  a  hospital  on  the  lower  east  side,  and  one 
in  the  uptown  district ;  and  within  two  years  following,  Gouverneur 
Hospital,  on  the  lower  east  side,  and  Harlem  Hospital  were  established,  re- 
lieving to  a  great  extent  the  overcrowded  condition  existing  at  the  time  in 
Bellevue,  Emergency,  and  99th  Street  Hospitals. 

By  this  time  there  was  a  very  general  feeling  that  the  existing  system 
under  which  the  paupers,  the  criminals,  the  lunatics,  and  the  sick  poor  were 
cared  for  by  one  department  was  highly  objectionable  and  should  be  done 
away  with.  A  bill  was  introduced  into  the  Legislature  providing  for  the 
division  of  the  Department  of  Public  Charities  and  Correction  into  four 
departments.  This  bill,  however,  was  not  passed,  but  the  campaign  for 
more  adequate  administration  of  the  institutions  then  under  the  supervision 
of  the  Department  of  Public  Charities  and  Correction  did  not  cease,  and 


434 


HOSPITAL   COMMITTEE 


finally,  in  1895,  a  law  was  passed  providing  for  the  division  of  this  De- 
partment into  two  distinct  bodies;  namely,  the  Department  of  Public  Chari- 
ties, placing  under  its  supervision  the  Hospitals,  the  Almshouse,  Lunatic 
Asylum,  and  all  institutions  on  Randall's  Island ;  and  the  Department  of 
Correction,  to  take  charge  of  all  penal  and  reformatory  institutions.  On 
February  i,  1902,  the  City  Charter  was  further  revised,  and,  pursuant  to 
additional  provisions,  the  control  of  Bellevue  Hospital  and  its  dependencies 
— Emergency,  Gouverneur,  Harlem,  and  Fordham  Hospitals — passed  from 
the  Department  of  Public  Charities  to  the  Board  of  Trustees  of  Bellevue 
and  Allied  Hospitals.  The  managing  Board  of  Trustees  consisted  of  seven 
unpaid  members,  and  the  Commissioner  of  Public  Charities  as  an  additional 
member,  ex  officio. 

A  statement  of  the  expenditure  for  dependents  from  1850  to  date  fol- 
lows: 


Expenditures 
per  Capita 
of  Popula- 
tion 


For  Prisoners  For  Dependents 

and  Dependents  in  Private 

Year           Population  in  Public  Alms-  and  State  Total 

houses  and  Homes  and 

Hospitals  Hospitals 

1850 515,547       $421,882.00           S9,863.00  S431,745.00  SO. 83 

1860 813,669         746,549 .  00         128,850 .  00  875,399 .00  1 .  07 

1870 942,292      1,355,615 .  00         334,828 .  00  1,690,443 .00  1 .  79 

1880 1,206,577      1,373,383.34  1,414,257.00  2,787,640.34  2.31 

1890 1,600,000      1,999,300.00  1,845,872.00  3,845,172.00  2.40 

1900 3,437,202      2,760,780 .  97  3,079,259 .  60  5,840,040 .57  1 .  69 

1910 4,766,883      5,919,912.66  4,902,859.26  10,822,771.92  2.27 

1911 4,973,000      6,487,420.16  4,800,857.00  11,288,277.16  2.26 

1912 5,173,000      6,726,036.38  4,975,781.00  11,701,817.38  2.25 


Expenditures  for  the  care  of  Dependents  exclusive  of  those  in  the  correctional  institutions: 


Dependents  in  D^R«^"^dente"i 

Year             Population         Public  gtete  Homes             Total 

Institutions  ^nd  Institutions 

1900 3,437,202    $1,998,005 .  97  $3,079,259 .  60  $5,077,046 .  57 

1910 4,766,883      4,648,562.76  4,902,859.26  9,551,422.02 

1911 4,973,000      5,220,705.66  4,800,857.00  10,021,562.66 

1912 5,173,000      5,426,599.38  4,975,781.00  10,402,380.38 


Expenditures 
per  Capita 
of  Popula- 
tion 


SI.  47 
2.00 
2.03 
2.01 


It  will  be  noted,  by  reviewing  the  figures  in  the  foregoing  table,  that  the 
expenditure  per  capita  of  population  in  the  City  for  the  support  of  pris- 
oners, the  sick,  and  the  dependent,  reached  its  maximum  in  the  decade  be- 
ginning with  1890,  and  was  at  that  time  $2.40.  But  by  1900  the  expendi- 
ture per  capita  of  population  had  been  reduced  to  $1.69,  and  in  1912  it 
was  $2.25.  The  decreased  expenditure  per  capita  of  the  population  in  1900 
and  1912,  compared  with  1890,  does  not  indicate  that  less  efficient  service 
was  rendered  in  the  later  years  than  formerly.  Unquestionably  the  building 
accommodations,  and  the  methods  of  caring  for  the  sick  and  the  dependent 
at  the  present  time  are  much  better  than  two  decades  ago.  The  reduced  per 
capita  expenditure  was  probably  due  to  increased  efficiency,  since  more 
service  is  being  rendered  to-day  than  twenty  years  ago.    It  would  not  seem 


EMPLOYMENT   OF   INMATES  435 

to  be  a  wise  policy  on  the  part  of  the  City,  however,  to  reduce  the  amount 
devoted  to  the  care  of  dependents  because  increased  eiificiency  has  lessened 
the  cost.  It  would  be  a  wiser  policy  to  increase  the  standard  of  efficiency, 
and  at  the  same  time  to  expend  the  amount  of  money  thus  saved,  in  im- 
proving the  physical  plants,  and  in  caring  for  the  sick  and  poor. 

The  history  of  the  development  of  the  care  of  dependents  given  in  the 
preceding  pages  makes  it  clear  that  methods  have  been  markedly  improved 
within  the  last  hundred  years,  but  the  goal  of  adequate  care  has  by  no 
means  been  reached,  and  much  more  should  be  done  to  improve  the  sur- 
roundings in  which  our  dependents  pass  their  last  days.  The  recommenda- 
tions made  in  the  report  are  designed  to  raise  this  standard,  and  the  cost 
of  carrying  them  into  execution  will  probably  not  materially  increase  the 
per  capita  cost,  if,  at  the  same  time,  the  recommendations  for  increased 
efficiency  in  the  Department  be  put  into  effect. 


THE  INVESTIGATION 

A  cursory  examination  of  the  work  done  by  inmates  in  the  City  Homes 
indicates  that  no  systematic  effort  has  been  put  forward  to  provide  a  variety 
of  forms  of  work  which  might  be  adapted  to  the  physical  and  mental  ability 
of  the  inmates.  A  certain  proportion  of  the  inmates,  those  who  are  consid- 
ered by  the  superintendents  of  the  institutions  to  be  able  to  do  physical  work, 
are  employed  in  helping  to  care  for  the  buildings  and  grounds,  but  the 
amount  of  industrial  work  provided  for  inmates  unable  to  do  work  about 
the  buildings  is  quite  limited. 

The  City  Home,  Manhattan,  has  a  broom  shop,  but  it  is  operated  to  a 
very  limited  degree.  One  man  is  employed,  and  a  few  inmates  at  times 
help  him.  At  the  time  of  examining  the  work.  June  9,  1913,  i  man  was 
occupied  in  the  shop.  At  this  same  time  3  men  were  employed  in  mattress- 
making  ;  2  men  in  the  tin  shop ;  4  men  in  the  carpenter  shop ;  and  4  men  in 
the  shoe  shop.  The  number  of  women  in  the  sewing  room  varies.  The 
bulk  of  the  sewing,  however,  is  done  by  paid  women. 

In  the  City  Home,  Brooklyn,  about  10  men  are  occupied  at  mattress- 
making  ;  6  in  making  bandages ;  3  in  repairing  shoes ;  3  to  5  in  the  carpenter 
shop ;  and  10  or  12  men  in  the  tailor  shop.  Nearly  all  of  the  sewing  is  done 
by  inmates,  from  30  to  50  women  being  occupied  in  this  way. 

At  Farm  Colony  usually  about  3  men  are  occupied  in  the  shoe  shop; 
I  to  3  men  in  making  harness ;  5  to  10  men  in  the  carpenter  shop ;  and 
about  the  same  number  in  the  tailor  shop.  From  15  to  20  women  are  occu- 
pied in  the  sewing  room.  Since  January  i,  1913,  a  man  has  been  employed 
to  teach  rug  making,  and  about  60  men  have  been  engaged  in  this  work. 

A  much  larger  number  of  inmates  are  employed  in  performing  work 
connected  with  the  Colony,  such  as  cleaning,  making  beds,  work  on  the 
grounds,  in  the  power  house,  laundry,  and  a  large  number  of  miscellaneous 
tasks.  At  the  Manhattan  Home  an  average  of  about  600  people  are  thus 
employed ;  at  the  Brooklyn  Home  about  500 ;  and  at  Farm  Colony  about  400. 

The  total  number  employed  in  any  one  of  the  institutions,  whether  at 
industrial  work  or  in  caring  for  the  institution,  is  not  a  major  proportion 
of  the  total  inmates  in  the  institution.  It  is  the  belief  of  some  of  our  most 
enlightened  almshouse  experts  that  it  is  possible  and  advisable  to  furnish 
employment  for  every  inmate  not  actually  sick  in  bed.  A  large  proportion 
of  the  inmates  in  the  almshouses  in  New  York  City  are  apparently  unable 
to  do  heavy  or  even  moderately  heavy  work,  but  they  are  apparently  able 
to  do  a  variety  of  light  industrial  work  that  would  require  little  exertion 
and  effort.  Thus  far  there  has  been  no  systematic  attempt  made  to  ascertain 
the  number  of  people  that  could  be  so  employed,  or  to  devise  means  and 
methods  of  employing  such. 

At  no  time,  either  during  the  process  of  admission  or  after  arriving  in 
the  institutions,  is  a  physical  examination  made  of  the  inmates  to  determine 
their  condition  or  ability  to  work.  An  examination  is  made  of  applicants  at 
the  office  of  the  Manhattan  Bureau  of  Dependent  Adults,  but  this  examina- 
tion is  limited  to  a  very  superficial  test  to  determine  whether  the  applicant 
should  be  sent  to  one  of  the  hospitals  of  the  Department  or  to  an  alms- 
house.    The  examination  is  not  of  a  character  to  determine  the  physical 

437 


438  HOSPITAL  COMMITTEE 

condition  of  a  person  not  evidently  sick.  After  these  dependents  arrive  in 
the  institutions  as  inmates  they  are  assigned  to  the  hospital  wards,  the  wards 
for  the  infirm  and  crippled,  or  to  the  dormitories,  on  the  judgment  of  the 
Superintendent,  who,  in  both  the  Manhattan  Home  and  Farm  Colony,  is  a 
layman.  In  the  Brooklyn  Home,  though  nominally  the  Superintendent 
of  the  Kings  County  Hospital  is  Superintendent  of  the  Home,  the  major 
part  of  the  administrative  duties  are  actually  carried  on  by  a  subordinate 
officer,  who  is  a  layman,  and  the  work  of  distributing  the  inmates  is  per- 
formed by  this  layman. 

The  determination  of  which  of  the  inmates  is  or  is  not  able  to  work 
rests  with  the  lay  superintendent.  The  result  is  that  in  many  cases  men 
who  are  amply  able  to  work  will  not  do  so,  on  the  claim  that  they  are  un- 
able because  of  physical  disability,  and  the  Superintendent,  fearing  lest  his 
judgment  may  be  wrong,  accepts  the  excuse  of  such  unwilling  inmates.  In 
other  cases  men  who  are  willing  are  put  to  work,  on  the  supposition  that 
they  are  able  because  they  are  willing,  when  a  close  examination  would 
show  that  such  men,  if  put  to  work  at  all,  should  be  occupied  only  with 
light,  sedentary  labor.  Corroboration  of  the  above  statements  will  be  found 
in  the  record  of  inmates  physically  examined,  set  forth  on  subsequent  pages. 

Farm  Colony  was  established  in  1902,  for  the  purpose  of  sending  to 
this  place  all  inmates  who  were  relatively  able-bodied  and  able  to  do  the 
various  types  of  work  in  connection  with  operating  a  farm.  This  original 
program  was  adhered  to  for  the  first  few  years,  and  then  those  less  able  to 
work  were  also  sent  to  the  Colony.  The  classification  of  the  Department 
now  shows  that  over  34  per  cent,  of  the  inmates  of  the  Colony  are  crippled, 
deformed,  or  senile. 

The  need  of  medical  attention  by  any  inmate  is  not  determined  by  a 
regular  system  of  examination  or  inspection,  but  by  the  fact  that  an  inmate 
does  not  get  up  at  rising  time.  When  an  inmate  remains  in  bed  and  com- 
plains of  being  sick  the  fact  is  reported  by  the  dormitory  attendant 
and  a  physician  makes  an  examination.  But  many  persons  are  sick  and  in 
need  of  medical  attention  who  do  not  remain  in  bed.  As  is  well  known, 
many  persons  will  not  complain  when  feeling  far  from  well,  and  when 
they  are  evidently  in  need  of  medical  care.  This  is  quite  as  true  of  inmates 
of  almshouses  as  of  those  who  are  not  so  unfortunate  as  to  be  dependent 
upon  the  public  for  support. 

The  above  recited  conditions,  viz. : 

1.  That  inmates  were  admitted  without  full  physical  examination; 

2.  That  inmates  were  not  physically  examined  after  reaching  the  insti- 

tutions ; 

3.  That  inmates  were  put  to  work,  or  allowed  to  remain  idle,  solely 

upon  the  judgment  of  a  layman  as  to  their  physical  ability; 

4.  That  no  systematic  method  of  determining  the  degree  of  health  or 

sickness  of  the  inmates  existed, 

prompted  your  investigator  to  have  a  thorough  physical  examination  made 
of  a  reasonable  proportion  of  the  inmates  of  the  Homes  to  determine : 

(al     The  relative  proportion  of  the  inmates  who  were  sick,  infirm,  or 
crippled ; 


EMPLOYMENT   OF  INMATES  439 

(b)  The  proportion,  who,  though  not  able-bodied,  yet  were  able  to  do 

light  industrial  work; 

(c)  The  proportion  that  were  relatively  able-bodied  and  able  to  do  a 

fair  amount  of  work  daily. 

This  examination  was  placed  under  the  charge  of  Dr.  L.  L.  Williams, 
Medical  Investigator  for  the  Committee.  Dr.  Williams  has  gained  broad 
experience  in  such  matters  through  his  activity  at  Ellis  Island,  the  medical 
work  of  which  station  he  now  has  in  charge.  His  report,  which  is  contained 
on  subsequent  pages,  describes  the  method  of  examination  and  the  results 
obtained. 

The  extended  and  careful  physical  examination  of  the  inmates  carried 
on  by  Dr.  Williams  has  shown  that  about  60  per  cent,  of  the  total  inmate 
population  is  probably  able  to  do  work,  ranging  from  heavy  farm  tasks  to 
light  industrial  employment.  Sixty  per  cent,  of  the  total  population  would 
represent  about  3,000  inmates.  At  the  present  time  there  are  daily  em- 
ployed in  the  three  City  Homes  not  to  exceed  1,500  persons.  It  would 
seem,  therefore,  that  an  estimated  number  of  about  1,500  inmates  who 
are  now  idle  could  do  some  form  of  light  work  if  suitable  devices  and 
machinery  were  installed.  Such  employment  would  probably  yield  a  return 
that  should  more  than  offset  the  cost  of  machinery  necessary  to  provide 
employment,  and,  at  the  same  time,  would  contribute  largely  to  the  content- 
ment, happiness,  and  well-being  of  the  inmates. 

To  ascertain  the  extent  to  which  inmates  in  almshouses  in  other  cities 
and  states  are  now  employed,  and  the  nature  of  their  employment,  an  inquiry 
was  made  of  some  of  the  leading  Almshouses  in  Massachusetts,  Rhode 
Island,  Pennsylvania,  Ohio,  Illinois,  and  Missouri.  A  large  percentage  of 
the  inmates  of  the  Almshouses  in  Massachusetts  were  employed,  but  inas- 
much as  the  Almshouse  population  is  housed  in  the  same  institution  with 
the  insane  and  vagrants,  it  was  impossible  to  ascertain  what  proportion  of 
the  work  was  done  by  the  dependents  and  what  by  the  other  classes.  Some 
information  of  value  was  secured  from  the  Almshouses  in  Philadelphia  and 
St.  Louis.  The  Almshouses  in  the  other  states  had  developed  industrial 
work  in  but  a  minor  degree,  and,  therefore,  had  little  to  offer  in  the  way  of 
suggestions.  Where  special  attention  had  been  given  to  the  employment 
of  inmates  the  institutional  management  claimed  that  the  value  of  the 
product  of  the  inmates  much  more  than  offset  the  cost  of  machinery  neces- 
sary to  employ  them  and  supervision  for  the  purpose  of  instructing  them. 


THE   EXAMINATION 

BV 

Dr.  L.  L.  Williams 

Mr.  Henry  C.  Wright, 

Director  of  Hospital  Inquiry. 
Sir: — 

In  compliance  with  your  request,  a  tentative  memorandum  for  the  use 
of  physicians  who  may  be  employed  in  making  physical  examinations  of  the 
inmates  of  the  City  Homes  of  the  Department  of  Public  Charities  has  been 
prepared ;  the  memorandum,  including  an  occupational  index  and  form  of 
medical  record,  is  appended  hereto. 

In  accordance  with  this  scheme  of  examination,  512  inmates  of  the  City 
Home,  Blackwell's  Island,  have  been  physically  examined.  The  examina- 
tions have  been  made  by  Dr.  John  H.  Carroll,  whose  work  has  resulted  in 
the  accumulation  of  material  of  much  practical  and  scientific  value.  In 
making  the  examination  various  groups  of  inmates  were  selected,  and  an 
effort  made  to  examine  a  sufficient  number  in  each  group  that  would  seem 
to  be  a  fair  cross  section  of  the  institution.  At  the  request  of  the  Commis- 
sioner of  Public  Charities  the  examination  has  been  confined  to  male  inmates. 

This  examination  had  a  two  fold  object:  First,  to  classify  these  in- 
mates on  the  basis  of  their  physical  and  mental  capacity,  in  order  that  some 
criterion  might  be  established  for  their  assignment,  in  accordance  with  their 
actual  condition,  to  either  the  hospital  wards  or  to  various  occupations  in 
the  City  Homes.  Second,  that  the  percentage  of  morbidity  among  the  in- 
mates of  the  Homes  might  be  ascertained  and  the  question  of  the  necessity 
for  a  more  comprehensive  medical  supervision  of  all  the  residents  in  these 
institutions  be  given  consideration  in  the  light  of  the  actual  facts. 

The  inmates  examined  were  in  three  general  classes :  First,  those  who 
are  deemed  proper  subjects  for  active  medical  treatment,  and  are  desig- 
nated for  admission  to  the  medical,  surgical,  or  neurological  wards.  Sec- 
ond, those  who  by  reason  of  age,  incurable  disabling  disease,  deformity, 
the  results  of  injury,  or  mental  incapacity,  are  designated  for  care  under 
medical  supervision  in  wards  for  the  infirm  and  crippled.  Third,  those 
who  are  either  free  from  actual  disease,  or  who  are  the  subjects  of  disease 
of  a  chronic  character  which  does  not  wholly  incapacitate  them,  and  who 
are  designated  for  occupations  of  various  kinds. 

The  occupational  index,  constructed  for  the  purpose  of  still  further 
classifying  the  last  named  group  of  inmates,  divides  occupations  into  two 
groups,  heavy  work  and  light  work.  For  convenience  in  classification  these 
two  groups  are  subdivided,  and  under  the  head  of  heavy  work  are  placed 
heavy  farm  work,  heavy  mechanical  work,  and  domestic  work;  under  the 
head  of  light  work  are  placed  light  farm  work,  light  non-sedentary  me- 
chanical work,  and  light  sedentary  mechanical  work.  Examples  are  given 
in  the  occupational  index. 

The  proportions  of  the  number  examined,  with  suggested  assignment, 
are  shown  in  the  following  table : 

440 


EMPLOYMENT  OF  INMATES 


441 


Result  of  Physical  Examination  of  Dependents  in  City  Home,  Manhattan 
(Blackwell's  Island). 


Percentage 
Number  of  Total 

Examined        Number 
Examined 


Assigned  to  Occupations: 
Group  I. 

Heavy  Farm  Work 22 

Heavy  Mechanical  Work 42 

Domestic  Work 37 

Group  II. 

Light  Farm  Work 

Light  Mechanical  Work — Non-sedentary 

Light  Mechanical  Work — Sedentary 

Total  Number  Assigned  to  Industrial  Work 300 

Assigned  to  Hospitals: 

Assigned  to  Medical  Wards 76 

Assigned  to  Surgical  Wards 21 

Assigned  to  Neurological  Wards 18 

Total  Number  Requiring  Active  Treatment 115 

Assigned  to  Wards  for  Infirm  and  Crippled 97 

Total  Number  Requiring  Medical  Care 212 


4-3 
8.2 
7.2 


19 

3-7 

31 

6.1 

149 

29.1 

58.6 


14.9 
41 

3-5 


41.4 


512 


442  HOSPITAL   COMMITTEE 

While  the  majority  of  the  inmates  examined  were  persons  who  had  re- 
sided in  the  institutions  for  longer  or  shorter  periods,  78  newly  admitted 
inmates  were  also  examined ;  these  are  included  in  the  total  number  repre- 
sented in  the  table.  Of  the  new  admissions,  33,  or  42.4  per  cent.,  were 
assigned  to  the  hospital ;  45,  or  57.6  per  cent.,  were  designated  for  industrial 
occupation.  It  should  be  explained  that  this  examination  was  made  in  the 
spring,  when  fewer  persons  seek  admission  than  in  the  fall  and  winter,  and 
when  those  who  do  apply  probably  show  a  higher  percentage  of  actual  dis- 
ability. Among  those  found  to  be  in  need  of  medical  care,  and  who  were 
designated  for  admission  to  hospital,  were  4  persons  who  are  now  required 
to  perform  labor  in  the  Home. 

Such  instances  exemplify  the  propriety  of  a  careful  physical  examina- 
tion before  assigning  inmates  to  occupations,  as  well  as  the  advantage  of 
medical  supervision  after  such  assignment.  Many  of  these  persons,  for 
their  own  good,  should  be  put  at  work  of  some  kind ;  not  only  should  care 
be  taken  to  assign  them  to  occupations  proportioned  to  their  strength,  but 
they  should  also  be  under  observation  afterward,  in  order  that  they  may  be 
removed  to  the  hospital  section  when  it  becomes  apparent  that  they  are  no 
longer  fit  for  labor. 

Of  active  pulmonary  tuberculosis,  15  cases  were  found  among  the  in- 
mates examined.  The  finding  of  cases  of  this  kind  in  congested  bar- 
rack rooms  accentuates  the  necessity  for  a  careful  examination  of  all  in- 
mates. 

As  the  older  inmates  need  glasses  for  correct  vision,  and  all  are  not 
provided  with  them,  it  would  seem  proper  that  glasses  be  furnished  by  the 
City  for  those  needing  them.  Such  provision  would  add  to  the  comfort  of 
these  inmates,  and  is  essential  for  those  assigned  to  certain  kinds  of 
work. 

It  is  of  interest  to  compare  the  results  of  this  examination  with  the 
classification  of  inmates  of  the  New  York  City  Home  in  the  Annual  Re- 
port of  the  State  Board  of  Charities  for  191 1  (page  128),  which  states  as 
follows : 

"The  total  number  of  inmates,  September  30,  191 1,  was  2,675.  Of  these, 
1,246,  or  46  per  cent.,  were  classed  as  able-bodied:  the  remainder,  54  per 
cent.,  were  classed  as  sick  or  infirm,  feeble-minded  or  idiotic,  epileptic, 
blind,  or  deaf."  This  examination  finds  the  proportions  somewhat  different 
than  those  reported  by  the  State  Board  of  Charities.  The  sick,  infirm,  etc., 
constituted  41.41  per  cent.,  and  those  able  to  do  some  work,  58.59  per 
cent. 

It  has  been  found,  however,  that  52.8  per  cent,  of  the  persons  desig- 
nated for  industrial  work — especially  the  lighter  varieties — suffer  from  ac- 
tual disease.  Many  others  in  this  class,  while  not  obviously  diseased,  are 
more  or  less  infirm,  on  account  of  age,  alcoholic  habits,  etc.  None  of  these 
can  fairly  be  classed  as  able-bodied,  in  the  usual  sense  of  the  term,  except 
those  assigned  to  heavy  work  (who  constitute  19.7  per  cent.,  as  shown  in 
table.  Group  I).  Even  in  this  group  some  of  the  inmates  assigned  to  do- 
mestic work  (Group  I,  No.  3  of  Occupational  Index)  are  only  relatively 
active  or  able-bodied.  A  stated  proportion  of  46  per  cent,  able-bodied 
persons  would,  therefore,  unless  qualified,  give  an  erroneous  impression, 
if  the  results  of  this  examination  of  a  portion  of  the  inmates  gives  a  fairly 
accurate  index  of  the  morbidity  in  the  entire  institution. 

Of  the  300  inmates  of  the  Home  regarded  as  fit  for  occupation,  mainly 
light  work,  209,  or  69.6  per  cent.,  suffer  from  chronic  diseases  of  various 


EMPLOYMENT   OF  INMATES  443 

kinds.  Many  of  them,  for  instance,  have  disease  of  the  heart,  "compen- 
sated" at  present,  but  liable  to  require  treatment  at  any  time.  Adding  thij 
number  to  those  assigned  to  the  hospital  wards  we  have  421  inmates  who 
are  afflicted  with  disease  or  injury  of  some  kind,  or  a  total  morbidity  of 
82.2  per  cent,  of  the  entire  number  examined.  With  such  a  percentage  of 
morbidity,  and,  considering  the  fact  that  many  of  the  inmates  who  are  free 
from  definite  disease  are  old  and  more  or  less  infirm,  it  seems  advisable  that 
the  entire  institution,  the  barracks  as  well  as  the  infirmary  wards,  be  sub- 
ject to  medical  visitation  at  frequent  intervals.  These  people,  belonging,  as 
they  do,  to  the  army  of  the  "down  and  out,"  accustomed  to  institutional 
routine  and  to  submit  to  authority  without  question,  are  indisposed — many 
of  them  at  least — to  voluntarily  exploit  their  ailments.  A  plea  is  made  for 
such  medical  supervision  of  the  institution  as  has  been  suggested,  and  it  is 
believed  that  such  provision  will  commend  itself  to  all  who  give  considera- 
tion to  the  facts  and  who  are  alive  to  the  necessity  of  conserving  the  in- 
terests of  those  who,  because  of  their  unfortunate  condition,  are  deprived 
of  a  voice  in  that  which  most  concerns  them.  Considerable  labor  will  be 
required  in  the  first  instance  to  make  a  physical  examination  of  all  in- 
mates. Once  this  is  accomplished,  however,  and  the  records  indexed,  the 
examination  of  those  admitted  daily  and  the  necessary  medical  oversight 
of  all  inmates  will  not  require  a  large  force  or  involve  any  heavy  outlay. 
In  the  process  of  examining  somewhat  over  500  inmates  it  was  found  that 
the  physical  examination  indicated  by  the  appended  instruction  and  blanks 
could  be  performed,  on  an  average,  in  about  fifteen  minutes  for  each  indi- 
vidual. In  some  cases,  in  which  the  physical  condition  was  evident,  the  time 
required  was  smaller,  and  in  other  cases,  where  it  was  necessary  to  make 
more  tests,  the  time  required  was  longer.  In  the  whole  number  of  cases, 
however,  the  average  was  about  as  indicated.  It  may  be  assumed  that 
should  the  Department  undertake  to  physically  examine,  to  the  extent  used 
in  this  experimental  inquiry,  all  inmates  taken  into  the  institutions,  the  time 
required  day  by  day  would  average  about  15  minutes  per  inmate. 

Respectfully  yours, 

L.  L.  Williams,  M.D. 

Memoranda  for  Medical  Examiners 

The  objects  of  the  physical  examination  and  classification  of  the  in- 
mates of  the  institutions  of  the  Department  of  Charities  are : 

1st.  That  the  dependent  poor  of  the  City  may  be  divided  into  groups 
with  a  view  to  their  distribution  in  the  several  institutions  under  such 
conditions  of  care  and  occupation  as  may  be  most  conducive  to  their  men- 
tal and  physical  well-being. 

2nd.  That  the  cost  of  their  maintenance  may  be  reduced  by  the  prod- 
ucts of  the  various  occupations  to  which  some  of  them  may  be  assigned, 
such  assignment  to  be  governed  primarily  by  consideration  of  their  own 
best  interests. 

3rd.  To  relieve  the  supervising  officers  of  the  several  institutions  of 
responsibility  in  assigning  inmates  to  occupations,  especially  to  those  of  a 
laborious  character. 


444  HOSPITAL  COMMITTEE 

Statement  of  Inmate  or  Relatives 

Upon  the  admission  of  an  inmate  to  the  reception  ward  obtain  from  him, 
or  from  his  relatives  or  friends,  all  the  information  available  which  may 
throw  light  upon  his  present  condition.  This  statement  should  include  the 
inmate's  age ;  sex ;  family  history,  especially  as  to  insanity ;  nervous  disease 
or  tuberculosis ;  occupation ;  habits,  as  to  the  use  of  alcohol  or  drugs ;  pre- 
vious diseases  from  which  he  may  have  suffered ;  present  disability,  if  any. 

Routine  Physical  Examination  (All  Cases) 

A  preliminary  examination,  without  removal  of  clothing,  will  be  suffi- 
cient to  determine  the  groups  into  which  a  considerable  proportion  of  the 
inmates  would  fall  and  the  kind  of  work  for  which  they  are  best  fitted;  a 
more  extended  examination  being  reserved  for  cases  in  which  there  is 
doubt  as  to  the  proper  classification,  or  in  which  there  is  some  obvious  in- 
dication for  a  more  searching  inquiry. 

At  this  initial  examination  the  following  points  should  be  noted  and  re- 
corded : 

Physique,  whether  robust,  good,  fair,  or  poor;  nutrition,  whether  well 
or  poorly  nourished,  obese  or  emaciated;  color;  obvious  disease  or  de- 
formity; obvious  disordered  movements;  character  of  breathing;  pulse,  as 
to  rate  and  character;  arteries,  as  to  apparent  tension  or  degree  of  rigidity; 
muscular  power  and  freedom  of  mobility  of  joints  of  upper  extremity,  of 
lower  extremity,  and  of  spine;  obvious  abnormal  conditions  of  eyes  and 
acuity  of  vision  in  each  eye;  acuteness  of  hearing  and  obvious  abnormal 
conditions  of  ears ;  abnormal  conditions  of  nose,  mouth,  and  throat ;  de- 
fects of  speech ;  obvious  mental  defects. 

The  inmate  should  be  questioned  as  to  the  existence  of  any  disability, 
and  his  statement  as  to  the  alleged  presence  of  diseased  conditions  verified 
in  every  instance. 

The  physique,  nutrition,  and  color  will  give  valuable  indications  as  to 
the  state  of  the  general  health ;  a  markedly  frail  physique,  malnutrition,  or 
a  dusky,  congested,  pallid,  or  yellow  skin,  should  be  regarded  as  sufficient 
indication  for  a  careful  inquiry  into  the  condition  of  the  thoracic  and  ab- 
dominal organs. 

The  neck  should  be  examined  for  goitre,  enlarged  glands,  or  pulsating 
veins. 

The  muscular  power  and  mobility  of  joints  should  be  tested  by  causing 
the  inmate  to  execute  certain  movements.  The  following  movements  are 
suggested  to  be  carried  out,  wholly  or  in  part,  in  the  discretion  of  the  exam- 
ining officer: 

Upper  Extremity:  Clasp  hands  above  head  and  behind  back;  circum- 
duct humerus :  strike  from  shoulder ;  flex,  extend,  pronate,  and  supinate 
forearms;  flex  and  extend  wrists;  open  and  close  hands;  spread  fingers; 
test  strength  of  grip  in  each  hand. 

Spine:  Extension;  flexion,  with  knees  held  in  extension;  lateral  move- 
ments; rotation. 

Lower  Extremity:  Simultaneous  flexion  of  legs  and  thighs  (sitting  on 
heels)  ;  rise  on  toes ;  abduct,  adduct,  and  rotate  thighs.  In  the  case  of 
women  some  of  these  movements  may  be  omitted  or  modified,  especially  if 
there  is  good  reason  to  do  so,  such  as  apparent  defect  of  movement  of 


EMPLOYMENT   OF  INMATES  445 

the  lower  limbs,  or  complaint  of  disability  on  the  part  of  the  inmate.  In 
such  cases  the  examination  may  be  more  conveniently  conducted  while  the 
inmate  is  in  bed.  During  the  execution  of  these  movements  note  especially 
the  degree  of  mobility  of  the  spine,  indications  of  flat  foot,  the  existence  of 
crippling  deformities  of  the  joints,  or  evidences  of  dyspnoea  or  exhaustion. 
The  manner  in  which  the  above-named  movements  are  executed,  taken  in 
connection  with  the  general  appearance  and  physical  development,  should 
enable  the  examiner  to  form  a  fair  estimate  of  the  inmate's  muscular  power 
and  fitness  for  work. 

In  selected  cases  (fairly  able-bodied  men)  the  inmate's  agility  may  be 
tested  by  causing  him  to  run  back  and  forth  across  the  room  several  times, 
to  hop  alternately  on  each  foot,  and  perform  similar  exercises  which  will 
readily  suggest  themselves. 

While  these  tests  are  in  progress  the  rate  and  character  of  the  breathing 
should  be  noted,  and  the  test  discontinued  if  there  is  dyspnoea  or  any  sign 
of  exhaustion.  The  pulse  rate  should  be  taken,  and  the  character  of  the 
pulse  and  the  condition  of  the  radial  artery  noted.  In  determining  the  con- 
dition of  the  arteries,  as  to  elasticity  or  rigidity,  it  will  be  well  to  examine 
the  brachial  artery,  as  well  as  the  radial  or  temporal. 

In  the  course  of  the  examination  any  paralysis,  whether  general  or  lo- 
cal, incoordination  or  convulsive  movements,  tremor  and  limitation  of 
movement  from  deformity  or  disease  of  joints  will  become  apparent.  Crip- 
pling diseases  of  the  hands,  chronic  arthritis,  varicose  veins,  contractures, 
muscular  atrophy,  etc.,  should  be  carefully  looked  for. 

The  gait  should  be  noted,  whether  normal,  ataxic,  spastic,  staggering, 
hemiplegic,  etc. 

Eyes:  The  acuity  of  vision  in  each  eye  should  be  roughly  tested  with 
the  Snellen  types,  when  practicable,  and  all  cases  of  marked  defect  of 
vision  not  due  to  known  incurable  conditions  should  be  referred  to  the  eye 
clinic  for  expert  examination  and  correction  by  glasses  or  otherwise. 
Note  on  the  record  any  disease  of  the  eye  or  its  appendages  discoverable  by 
ordinary  inspection,  and  refer  to  the  clinic  all  cases  of  curable  disease  or 
suspected  disease.  Particular  attention  should  be  given  to  the  examination 
of  the  Hds  for  trachoma,  in  order  that  precautions  may  be  taken  to  prevent 
the  spread  of  infection  by  inmates  suffering  from  this  disease. 

Ears:  Test  the  acuteness  of  hearing  by  the  conversation  test.  This 
may  be  supplemented,  when  desired,  by  testing  each  ear  separately  with  the 
watch.  Note  the  presence  of  disease  or  deformity  of  the  external  ear,  dis- 
charge from  the  ear,  or  tenderness  over  the  mastoid.  Persons  with  ob- 
vious disease  or  suspected  disease  of  any  part  of  the  auditory  apparatus 
should  be  referred  to  the  clinic. 

Month,  Throat,  and  Nose:  Note  abnormal  conditions  present.  Refer 
cases  to  clinic  when  necessary. 

Speech,  Defects  of:  Carefully  note  all  defects  of  speech,  such  as  apha- 
sia, paralytic  defect  of  articulation,  scanning,  etc.,  which  may  be  of  value 
in  the  detection  of  nervous  lesions  and  in  estimating  the  degree  of  mental 
development  or  deterioration. 

Mental  Condition:  In  the  course  of  the  examination  a  fair  estimate 
of  the  inmate's  general  intelligence  should  be  gained.  His  general  be- 
havior, attitude,  quickness  of  apprehension,  peculiarities  of  conduct  or  lan- 
guage, emotional  outbreaks,  loquacity  or  taciturnity,  disordered  movements, 


446  HOSPITAL   COMMITTEE 

condition  of  pupils,  and  peculiarities  of  gait  will  all  give  valuable  informa- 
tion as  to  the  presence  of  mental  defect  or  deterioration.  In  many  instances 
departures  from  the  normal  will  not  be  detected  until  the  inmate  shall  have 
been  under  observation  for  a  time,  when  his  personal  habits,  peculiarities 
of  conduct,  etc.,  will  call  attention  to  his  condition. 

For  practical  purposes   abnormal  mental   conditions   may  be   classified 
under  the  following  headings: 
Mental  development : 

Normal.     Feeble-minded.     Imbecile.     Idiot. 
Mental  deterioration : 

None.     Slight.     Marked. 

To  be  Included  in  Examination  Before  Recommending  Laborious  Occupations 

Inmates  who  upon  preliminary  examination  appear  to  be  able  to  per- 
form work  involving  considerable  muscular  exertion  should  not  be  desig- 
nated as  fit  for  such  work  until  the  organs  of  the  chest  and  abdomen  have 
been  carefully  examined  and  the  presence  of  serious  disease  excluded.  The 
movements  named  in  the  physical  examination  should  be  fully  carried  out 
and  the  blood  pressure  taken. 

Chest:  The  examination  of  the  lungs  and  heart  may  best  be  done  im- 
mediately after  the  physical  exertion  involved  in  the  tests  for  muscular 
power  and  mobility  of  joints.  In  addition  to  the  examination  by  the  usual 
methods,  the  shape  and  mobility  of  the  chest  should  be  noted,  and  measure- 
ments taken  after  full  inspiration  and  expiration,  the  vital  capacity  being 
taken  with  the  spirometer,  if  desired.  Evidences  of  dilated  heart,  emphy- 
sema, or  other  lesion  likely  to  seriously  limit  muscular  exertion  should  be 
carefully  looked  for. 

Abdomen:  With  the  subject  erect,  examine  each  inguinal  canal  for 
hernia;  note  the  appearance,  muscular  sufficiency,  and  whether  there  is 
ptosis  of  viscera.  The  presence  or  absence  of  hemorrhoids  should  be  ascer- 
tained. 

With  the  subject  preferably  in  the  recumbent  position,  examine  for  evi- 
dence of  intra-abdominal  disease. 

Further  Physical  Examination    (When  Indicated  Only) 

A  more  comprehensive  examination  will  be  required  when  called  for 
by  indications  arising  during  the  preliminary  examination ;  such,  for  ex- 
ample, as  evidences  of  disease  or  deformity  of  spinal  or  other  joints,  evi- 
dences of  chronic  nervous  disease  of  doubtful  character,  or  suspected  syphi- 
litic disease. 

Inspection 

The  surface  of  the  body  should  be  inspected  after  the  clothing  has  been 
removed,  wholly  or  in  part,  as  may  be  necessary,  noting  the  general  muscular 
development ;  the  presence  of  eruptions,  ulcers,  or  scars ;  glandular  enlarge- 
ments, especially  in  the  epitrochlear  and  inguinal  regions :  varicose  veins ; 
deformities,  their  nature  and  extent;  evidences  of  former  disease  or  injury 
of  bones;  evidences  of  self-administered  hypodermic  injections. 

Genito-urinary  System 

(a)  In  women,  assume  to  be  normal,  unless  there  has  been  complaint 
from  inmate  or  report  from  relatives,  or  unless  evidence  of  pelvic  disease 


EMPLOYMENT   OF   INMATES  447 

has  been  obtained  by  the  previous  abdominal  examination.  If  special  ex- 
amination is  necessary,  refer  inmate  to  the  gynecological  clinic. 

(b)  In  men  make  superficial  examination  and  note  presence  of  obvious 
disease  or  abnormality  of  external  organs.  Otherwise  assume  to  be  nor- 
mal, unless  there  has  been  complaint  from  inmate  or  report  from  relatives 
or  attendants. 

For  any  necessary  special  examination  refer  to  clinic. 

Reflexes 

Examine  pupillary  reflexes,  and  note  presence  or  absence  of  knee-jerk, 
ankle  clonus,  Babinski  sign,  or  Romberg  sign. 

Laboratory  Test 

(a)  In  all  cases 

Urine:  As  a  routine  measure  the  examination  may  be  confined  to  the 
following:  reaction;  specific  gravity;  qualitative  tests  for  albumin  and 
for  sugar;  microscopical  examination  of  sediment,  if  any  is  present;  Was- 
sermann  test  when  indicated. 

(b)  When  indicated  only 

HcBmoglobin:  The  percentage  should  be  taken,  preferably  by  one  of 
the  rapid  methods,  such  as  the  Tallqvist  scale. 

Complete  laboratory  examination  of  urine  and  blood  may  be  under- 
taken when  called  for  by  special  indications  obtained  during  the  routine 
physical  examination. 

Sputum:  This  should  be  submitted  to  microscopic  examination  if 
there  is  cough  with  expectoration  and  the  physical  examination  of  the  chest 
leads  to  suspicion  that  tuberculosis  may  be  present. 

In  General 

The  object  of  the  examinations  should  be  constantly  borne  in  mind;  viz., 
the  betterment  of  the  inmate's  environment,  as  a  primary  consideration, 
and,  secondarily,  his  return  to  comparative  usefulness. 

The  preliminary  examination  will  suffice  for  the  elimination  from  further 
examination  of  those  who  are  obviously  able  to  work,  and  those  who  are  evi- 
dently sick  or  disabled,  the  more  complete  examination  being  reserved  for 
doubtful  cases. 

Note  and  record  any  condition  found  during  the  examination  which  may 
bear  upon  the  inmate's  capacity  for  work,  and  which  might  be  of  assistance 
in  determining  the  kind  and  degree  of  labor  he  could  safely  perform. 

The  examination  should  be  terminated  as  soon  as  it  becomes  evident 
that  the  inmate  should  be  sent  to  hospital.  It  should  also  be  discontinued 
when  it  gives  rise  to  marked  emotional  disturbance.  In  such  cases  it  may 
be  resumed  after  a  period  of  observation. 

Except  in  cases  in  which  there  is  doubt  whether  the  inmate  should  be 
sent  to  the  hospital  the  examination  may  be  abruptly  terminated  as  soon  as 
it  becomes  apparent  that  he  should  be  grouped  in  a  certain  class.  This  ap- 
pHes  particularly  to  inmates  suffering  from  certain  obvious  and  incurable 
conditions  which  manifestly  limit  their  working  capacity,  but  for  which 
nothing  can  be  done  in  the  way  of  treatment. 


448  HOSPITAL  COMMITTEE 

In  completing  the  record  form  give  a  resume  of  the  results  of  the 
examination,  in  the  form  of  a  diagnosis,  and  make  recommendations  as  to 
the  disposition  to  be  made  of  the  inmate,  in  conformity  with  the  subjoined 
schedule:  (In  case  a  diagnosis  is  obvious  it  will  be  unnecessary  to  fill  out 
many  of  the  details  of  the  blank.  In  some  instances,  in  which  there  is  an 
obvious  terminal  disability  of  doubtful  origin,  the  diagnosis  may  be  re- 
corded in  general  terms,  which  should  be  sufficiently  explicit  to  indicate  the 
nature  of  the  disability  without  necessarily  entering  into  questions  of  causa- 
tion or  pathology.) 

Recommendation  to  be  Made 

(i)     To  be  sent  to  hospital. 

A.  Medical:  Acute  Chronic 

B.  Surgical:  Acute  Chronic 

C.  Neurological. 

D.  Wards  for  Infirm  and  Cripples. 

(2)  Occupational  Index.     Group  i :  Nos.  123 

(3)  Occupational  Index.     Group  2 :  Nos.  456 

The  number  of  hours'  work  per  diem  deemed  suitable  in  each  case 
should  be  included  in  the  recommendation,  and,  when  practicable,  several 
occupations  should  be  designated  by  their  appropriate  numbers,  due  regard 
being  had  to  the  inmate's  predilections  and  previous  occupation. 

In  case  of  failure  of  the  inmate  to  fit  the  environment  recommended  he 
should  be  reported  to  the  medical  examiner  for  further  examination  and 
recommendation. 

An  occupational  index  is  appended  for  the  information  of  medical  ex- 
aminers. 

A  record  blank  suggested  for  use  in  recording  the  results  of  physical 
examinations  is  appended. 

The  record  is  to  be  filed,  and  subsequent  data  of  a  pertinent  kind, 
whether  of  a  medical  nature  or  bearing  upon  the  inmate's  adaptability  to 
certain  kinds  of  work,  may  be  added  from  time  to  time. 

The  official  number  of  the  inmate  should  be  recorded  on  the  form. 

Upon  the  death,  discharge,  or  transfer  of  the  inmate,  the  date  will  be 
recorded  and  the  record  permanently  filed. 

If  readmitted  there  should  be  cross  references  on  the  old  and  the  new 
form,  making  a  continuous  record  in  each  case. 


Occupational  Index 

Group  I. — Heavy  Work. 

1.  Heavy  Farm  Work;  such  as. 

Plowing 

Harrowing 

Harvesting 

Milking 

Teaming 

Stable  Work,  etc.  > 

2.  Heavy  Mechanical  Work;  such  as, 

Masonry  ' 

Road  Making 

Carpentering 

Plumbing 

Steam  Fitting 

Gas  Fitting 

Fire  Room,  etc. 

3.  Domestic  Work;  such  as. 

Laundry- 
Kitchen 
Dining  Room 
Care  of  Wards 
Cleaning 
Care  of  Grounds,  etc. 

Group  II. — Light  Work. 

4.  Light  Farm  Work;  such  as, 

Planting 

Weeding 

Care  of  Stock 

Poultry  Yard 

Fruit  and  Vegetable  Canning 

Care  of  Lawns,  etc. 

5.  Light  Mechanical  Work,  Non-sedentary;  such  as, 

Cabinet  Making 

Upholstering 

Painting 

Tin  Shop 

Tool  Repairing,  etc. 

6.  Light  Mechanical  Work,  Sedentary;  such  as, 

Sewing  Room 
Knitting 
Mat  Making 
Basket  Making 
Broom  Making 
Tailor  Shop 
Clerical  Work. 

449 


450  HOSPITAL   COMMITTEE 


Medical  Record  of  Inmates. 

Record  No Institution. 

Name Sex Age Occupation 

Habits:    Alcohol 

Drugs Family  History 


Previous  Diseases Present  Disability 

Phys.  Exam:    Physique Nutrition Temp 

Obvious  Disease  or  Deformity 

Eyes Ears Skin 

Nose Mouth Throat 

Chest:    Mobility Inspiration In.     Expiration In. 

Heart Lungs 

Blood  Presstire Arteries Veins 

Abdominal  Organs 

Muscular  Power  and  Mobility  of  Joints 

Genito-urinary  Organs 

Nervous  System 

Reflexes:    Pupillary Knee  Jerk 

Babinski Ankle  Clonus Romberg 

Mental  Development:    Normal.     Feeble-Minded.     Imbecile.     Idiot 

Mental  Deterioration:     None.     Slight.     Marked 

[over] 


(Reverse  side) 


Lab.  Exam.:  Haemoglobin Sputum Wassermann. 

Urine:  Spec.  Grav Reaction Albumin Sugar  . 

Remarks:  


Diagnosis 

Recommendation:  A.  Medical    Acute 

1.  To  be  Sent  to  Hospital  Chronic. 

B.  Surgical    Acute. 


Chronic 

C.  Neurological 

D.  Wards  for  Infirm  and  Crippled. 

2.  Occupational  Index.     Group  1     Nos.  1 2 3. . . 

3.  Occupational  Index.     Group  2     Nos.  4 5 6. . . 

4.  To  be  Held  Temporarily  as:  Alien 

Non-resident 

Number  of  Hours  Work  per  Diem 

Subsequent  Data 


Transferred    ) 

Discharged      ) 19 . 

Died  ) 


EMPLOYMENT 

The  almshouse  for  the  City  of  St.  Louis,  Mo.,  is  located  within  the  City. 
It  is  surrounded  by  about  7  acres  of  ground,  used  for  gardening.  The 
average  number  of  inmates  during  1912  was  about  675.  Of  this  number, 
about  500  were  employed  daily  for  a  period  averaging  5  hours  per  individual. 
Thus,  about  y;^  per  cent,  of  the  total  population  are  occupied,  and  serve  in 
the  institution  in  some  useful  way.  These  inmates  work  for  23^  hours  in 
the  morning,  and  then  have  a  rest  period  of  about  3  hours,  followed  by 
zYz  hours  of  work  in  the  afternoon.  They  are  occupied  in  cultivating  the 
garden  in  connection  with  the  institution,  and  in  the  care  of  the  buildings 
and  grounds.  They  perform  nearly  all  the  services  in  the  buildings,  doing 
all  of  the  laundry  work,  all  of  the  sewing,  and  make  all  of  the  clothes  and 
shoes  for  the  inmates.  They  operate  a  soap  factory,  in  which  not  only  the 
soap  for  the  institution  is  produced,  but  additional  soap  for  other  city  in- 
stitutions. All  mattresses  used  in  the  institution  are  made  by  the  inmates, 
and  besides,  a  certain  number  are  sold  to  other  City  institutions.  A  carpen- 
ter shop  is  operated,  in  which  there  is  manufactured  a  good  proportion  of 
the  furniture  used  in  the  institution,  and  in  addition  to  the  carpenter  work 
in  the  shop,  repairing  is  done  to  the  buildings — this  activity  alone  during 
the  last  two  years  having  aggregated  in  value  about  $50,000.  A  book- 
binding shop  is  operated,  in  which  magazines  and  books  are  bound  for 
the  library  of  the  institution.  The  library  at  present  numbers  about  3,000 
volumes,  all  of  which  have  been  bound  by  the  inmates.  The  inmates  also 
erected  an  entertainment  hall,  about  60  x  80  feet  in  size,  and  manufactured 
for  it  sufficient  seats  to  seat  approximately  700  people.  They  constructed 
a  large  fountain  for  the  grounds ;  laid  the  water-main ;  and  have  done  many 
pieces  of  constructive  work  which  in  most  institutions  are  done  by  outside 
labor. 

The  superintendent  of  the  institution,  Mr.  W.  A.  Anderson,  stated  that 
comparatively  little  difficulty  is  found  in  inducing  the  inmates  to  work,  and 
that  an  atmosphere  of  contentment  and  happiness  exists  which  is  not  usually 
found  in  institutions  where  inmates  are  not  daily  occupied.  Our  investiga- 
tor was  convinced  that  the  statement  of  the  superintendent  with  regard 
to  the  contentment  of  the  inmates  was  true.  There  seemed  to  be  a  greater 
atmosphere  of  contentment  and  happiness,  and  cooperation  between  the  offi- 
cers, employees,  and  inmates,  than  at  any  other  almshouse  visited.  This 
he  attributed  most  largely  to  the  occupation  of  the  inmates.  Every  inmate, 
when  entering  the  institution,  is  given  to  understand  that  he  will  be  ex- 
pected to  labor  daily,  unless  he  is  considered  by  the  physician  in  attendance 
to  be  unable  to  perform  labor. 

The  almshouse  for  the  City  of  Pliiladelphia  is  located  within  the  City,  on 
a  plot  of  about  20  acres,  which  is  largely  occupied  by  the  buildings  of  the 
institution,  very  little  ground  being  devoted  to  gardening.  The  plant  itself 
is  old  and  out  of  repair,  badly  adapted  to  its  purpose,  and  much  over- 
crowded. Regardless  of  its  crowded  condition  much  industrial  work  is 
carried  on.     Its   average  population   in    1912  was   about   1,270,   of   which 

451 


452 


HOSPITAL   COMMITTEE 


about  725  were  men,  and  545  women.  The  men  are  not  only  employed  in 
the  wards  occupied  by  the  almshouse,  but  also  in  the  insane  asylum,  chil- 
dren's hospital,  and  the  general  hospital.  The  inmates  are  not  allowed  to 
serve  outside  of  the  almshouse  proper,  or  the  grounds,  so  that  the  number 
who  are  employed  at  labor  is  considerably  restricted.  Of  the  725  men, 
about  600  were  employed  daily.  Of  the  545  women,  only  about  130  were 
employed  daily.  In  addition  to  doing  the  general  work  of  the  various  insti- 
tutions mentioned,  which  harbor  about  7,000  inmates,  the  men  are  employed 
at  weaving,  making  shoes,  clothing,  mattresses,  brooms,  and  printing  re- 
ports and  forms,  for  their  own  and  the  Health  Department's  use.  At  these 
various  occupations  about  82  per  cent,  of  all  the  men  in  the  institution  are 
employed. 

Although  a  large  proportion  of  the  men  in  the  institution  are  employed, 
there  was  not  the  same  degree  of  contentment  noted  in  this  institution  as 
in  some  others,  probably  owing  to  the  fact  that  the  overcrowded  condition 
rendered  them  somewhat  uncomfortable.  The  overcrowded  condition  will 
be  relieved  comparatively  soon  by  two  new  institutions  which  are  to  be 
built,  one  of  which  is  now  under  process  of  construction. 

Most  almshouses  are  located  on  farms,  probably  for  the  reason  that  the 
inmates  can  be  more  readily  employed  at  farm  than  at  mechanical  labor. 
These  farms  generally  raise  standard  crops,  which  do  not  require  a  great 
amount  of  labor.  The  return  per  acre  does  not  vary  greatly  from  that  of 
the  average  privately  worked  farm. 

The  value  of  products  on  some  almshouse  farms  in  New  York  State  is 
set  forth  below: 

Value  of  Farm  Products  Produced  by  Inmates  of  Almshouses  of  New  York,  1911. 


Allegany  County 

Delaware        "        

Franklin         "        

Genesee  "        

Oswego  City 

Ontario  County 

St.  Lawrence  County 

Wyoming  "       

Yates  "       

Farm  Colony,  New  York  City. . 


Acreage 

Value 

Value 

Value 

Under 

Inmates 

of 

per 

per 

Cultivation 

Products 

Capita 

Acre 

183 

59 

88,814.10 

$149.39 

$48.16 

80 

39 

5,334.20 

136.77 

66.67 

100 

35 

6,891.54 

196.90 

68.91 

155 

51 

8,625.43 

169.12 

55.64 

47 

36 

7,623.71 

211.77 

162.20 

180 

69 

9,544.24 

161.76 

53.02 

150 

78 

13,144.71 

168.51 

87.63 

ISO 

40 

12,244.38 

306.10 

68.02 

165 

34 

6,847.96 

201.41 

41.50 

70 

703 

11,768.72 

16.74 

167.40 

A  review  of  the  figures  of  the  preceding  table  will  show  that  the  average 
value  of  products  per  acre  of  almshouse  farms  is  about  $60.  Two  of  the 
farms  exceeded  $100  per  acre,  of  which  two  Farm  Colony  of  New  York 
City  stands  the  highest,  with  $168  per  acre.  None  of  the  farms  other  than 
Farm  Colony  is  devoted  exclusively  to  truck  gardening.  Inasmuch  as  the 
value  of  garden  truck  is  much  greater  than  standard  crops,  a  farm  devoted 
to  truck  gardening  should  produce  a  crop  of  much  greater  value  than  a 
farm  devoted  to  general  crops. 

None  of  the  almshouse  farms  compare  in  productivity  with  the  State 
farms  of  Massachusetts.  The  report  of  these  farms  for  1911  is  given  as 
follows : 


EMPLOYMENT  OF  INMATES  453 

Value  of  Products  Produced  on  the  State  Farms  in  Massachusetts,  1911. 

Value  Produced 
Acres  of  Value  Produced  per  Acre,  Exclud- 
Tillage       During  Year       ing  Woodland 
and  Pasture 

State  Hospitals: 

Worcester 175  $59,732.80  $341.33 

Taunton 190  30,527.85  160.67 

Northampton 210  49,251.36  234.53 

Danvers 253  49,313.30  194.91 

Westborough 283  48,950.10  172.96 

Boston 165  26,849.30  162.71 

State  Asylums: 

Worcester 321  29,649.86  92.36 

Medfield 117  61,372.37  524.55 

Gardner  State  Colony 138  33,191.96  249.56 

Miscellaneous: 

Monson 156  36,219.62  232.17 

Foxborough 41  14,492.74  353.48 

School  for  Feeble-minded  at  Waltham 306  47,118.84  153.98 

Wrentham  School 58 11,296.94 194.77 

It  will  be  noted  that  the  Medfield  farm  produced  products  to  the  value 
of  $524;  Foxborough  farm  $353;  and  Worcester  farm  $341  per  acre. 
Three  other  farms  produced  more  than  $200  per  acre.  Each  of  these  insti- 
tutions has  many  relatively  able-bodied  inmates  who  can  do  efficient  work 
upon  farms.  In  general  they  are  a  stronger  class  than  the  almshouse  popu- 
lation. To  say  that  the  State  farms  of  Massachusetts  produce  more  per 
acre  than  the  almshouse  farms  would  mean  little,  owing  to  the  difference 
in  the  class  of  inmates.  It  is  noteworthy,  however,  that  an  institutional 
farm  can  be  made  to  produce  the  large  value  produced  by  the  farms  in 
Massachusetts.  It  would  indicate  that  the  farms  of  the  City's  almshouses 
are  not  handled  in  a  manner  to  secure  the  largest  results  possible. 

New  York  City  Farm  Colony,  though  producing  a  fair  amount  of  prod- 
uce per  acre,  does  not  approach  the  amount  produced  on  the  State  farms 
in  Massachusetts,  and  does  not  show  an  increased  production  according  to 
the  increase  in  the  number  of  inmates  in  the  institution.  The  following 
table  shows  the  record  of  the  institution  since  1902,  giving  the  number  of 
employees,  number  of  inmates,  and  the  value  of  the  products  of  the  farm. 

New  York  City  Farm  Colony  Farm  Products. 


Gross 

Net 

Year 

Em- 
ployees 

Depen- 
dents 

Value  of 
Crops 

Expenses 

Profit 

Profit 
per 

Profit 
per 

Dependent  Dependent 

1902... 

9 

115 

$4,571.50 

$1,268.44 

$3,303.06 

$39.75 

$28.72 

1903... 

..       12 

159 

5,410.40 

1,280.66 

4,129.84 

34.03 

25.97 

1904... 

..       11 

185 

12,676.52 

2,361.79 

10,314.73 

68.52 

55.76 

1905... 

..       20 

305 

14,294.53 

4,008.50 

10,286.03 

46.87 

33.72 

1906... 

..       30 

268 

9,513.33 

3,504.04 

6,009.29 

35.50 

22.42 

1907... 

..       38 

272 

13,857.57 

3,704.68 

10,152.89 

50.94 

37.32 

1908... 

..       35 

313 

7,583.08 

1,244.01 

6,339.07 

24.22 

20.25 

1909... 

..       40 

331 

10,602.93 

6,380.32 

4,222.61 

32.03 

12.76 

1910... 

..       42 

413 

8,925.32 

1911... 

..       58 

703 

11,768.72 

6,610.78 

5,157.94 

16.74 

7.33 

It  will  be  noticed  by  reviewing  the  above  table  that  in  1904,  with  11 
employees  and  185  inmates,  Farm  Colony  produced  crops  to  the  value  of 
$12,676.     In  191 1,  with  58  employees  and  703  inmates,  the  value  of  the 


454  HOSPITAL  COMMITTEE 

products  was  $11,768.  The  value  will  naturally  fluctuate  from  year  to 
year,  but  it  is  evident  that  the  gross  value  produced  at  the  present  time  is 
not  greater  than  when  the  employees  and  the  inmates  numbered  much 
less.  It  will  be  observed,  moreover,  that  the  expense  of  operating  the  Farm 
has  increased,  leaving  a  much  smaller  net  profit  from  the  produce. 

The  farm  operated  by  Manhattan  State  Hospital,  on  Ward's  Island, 
may  fairly  be  contrasted  with  the  farm  at  Farm  Colony.  Both  are  within 
the  City  limits,  and  both  devote  practically  their  entire  area  to  truck  gar- 
dening. Farm  Colony  uses  70  acres  for  this  purpose,  and  the  State  Hos- 
pital 63  acres.  The  Hospital  employs  in  cultivating  its  gardens  an  average 
of  about  80  men.  In  191 1  the  value  of  the  produce  at  Farm  Colony  was 
$11,768,  while  that  at  Ward's  Island,  with  7  acres  less,  was  $25,870.  The 
unit  values  of  produce  used  by  the  State  Hospital  were  less  than  those 
used  by  Farm  Colony.  Had  Farm  Colony  used  the  State  unit  values  its 
total  product  for  191 1  would  have  amounted  to  but  $8,051.00.  Thus  it  will 
be  observed  that  the  State  Hospital  farm  produced  over  three  times  as  much 
as  Farm  Colony.  The  contrast  in  the  amount  of  produce  on  the  two  farms 
is  marked. 

The  farm  on  Ward's  Island  is  under  the  supervision  of  the  State  De- 
partment of  Agriculture,  whose  agents  periodically  make  visits  and  offer 
suggestions.  The  farm  at  Farm  Colony  is  not  under  such  supervision, 
which  may  in  a  measure  account  for  the  difference.  It  would,  therefore, 
seem  advisable  for  the  Department  of  Charities  to  avail  itself  of  the  advice 
of  the  Department  of  Agriculture.  Though  the  physical  condition  of  the 
best  almshouse  population  is  not  equal  to  that  of  the  insane  in  the  State 
Hospital,  yet  the  strongest  of  the  male  inmates  are  able  to  do  considerable 
hard  labor,  and  if  only  the  relatively  able-bodied  were  sent  to  Farm  Col- 
ony, and  these  in  a  sufficient  number,  the  Colony  farm  could  be  made  to 
produce  nearly  or  quite  as  much  as  the  farm  connected  with  the  State  Hos- 
pital on  Ward's  Island. 

Dr.  Williams  has  shown,  as  a  result  of  his  physical  examination  of  in- 
mates, that  about  60  per  cent,  of  the  total  population  is  able  to  do  some 
work.  Sixty  per  cent,  of  the  total  population  of  approximately  5,000  would 
be  3,000.  Assuming  that  1,000  of  those  able  to  work  should  be  sent  to 
Farm  Colony,  and  that  800  would  be  employed  in  helping  to  care  for  and 
maintain  the  Homes  on  Blackwell's  Island  and  in  Brooklyn,  there  would  yet 
remain  1,200  who  could  do  some  form  of  light  industrial  work.  These 
people  at  the  present  time  are  unemployed,  and  are  less  happy  than  if  they 
were  occupied.  It  would  seem  highly  advisable  to  install  in  suitable  build- 
ings at  the  three  Homes  machinery  and  devices  which  could  be  oper- 
ated by  these  inmates.  The  kind  of  light  work  now  being  done,  such  as 
broom,  mattress,  and  rug  making,  could  well  be  enlarged  and  extended,  and, 
in  addition,  the  inmates  could  operate  simple  knitting  machines  for  the  pro- 
duction of  stockings,  sweaters,  caps,  mittens,  etc. ;  looms  for  the  weaving  of 
coarse  cloth,  from  which  clothing  could  be  made:  printing  presses  for  the 
printing  of  forms  to  be  used  in  the  institutions  and  other  Cit}'-  Departments ; 
bookbinding  devices ;  shoemaking  and  repairing  machinery  and  tools ;  and 
such  other  devices  and  forms  of  labor  as  may  be  found  on  experiment  suit- 
able for  the  class  of  inmates  in  our  City  Homes.  The  cost  of  such  ma- 
chinery and  devices  would  not  be  great.  Though  the  product  would  not 
be  sold  in  the  open  markets,  it  could  be  used  to  advantage  in  the  institu- 
tions and  other  City  Departments,  and  its  value  would  probably  more  than 
oflfset  the  cost  of  machinery,  buildings,  and  instructors  to  supervise  the 
work. 


Section  VIL— CARE  OF  OUT-PATIENTS 

1.  The   Out-Patient    Department    of   Gouverneur    Hospital 

2.  Suggestions    for     the    Organization    of    a    PubUc    Out- 

Patient    Department 

3.  Sickness   in   the   Home   and   Proposed   Health   Center 


I.   THE  OUT-PATIENT  DEPARTMENT  OF 
GOUVERNEUR  HOSPITAL 


THE  INVESTIGATION 

The  Importance  of  the  Dispensary 

A  house-to-house  canvass  of  certain  districts  of  the  City  to  discover 
conditions  of  sickness  revealed  the  fact  that  there  is  a  very  great  amount 
of  preventable  sickness  that  receives  either  no  medical  attention,  or  inade- 
quate medical  care.  (The  results  of  this  canvass  are  set  forth  on  pages 
519  to  534.)  Occurring  in  homes  where  ignorance,  poverty,  or  other  con- 
ditions make  a  proper  treatment  of  the  sickness  impossible,  the  diseases 
are  rendered  fatal,  or  protracted  beyond  their  normal  period,  or  become 
centers  of  contagion  for  the  community. 

The  most  effective  instrument  for  reaching  and  alleviating  these  condi- 
tions is  the  public  dispensary.  It  was  found  that  while  the  people  were 
disinchned,  for  various  reasons,  to  seek  relief  at  the  hospitals,  they  were 
anxious  to  utiHze  the  dispensaries,  but  were  deterred  by  the  conditions  ex- 
isting in  these  institutions.  In  the  large  majority  of  cases  one  visit  to  the 
dispensary  made  them  dissatisfied  with  the  treatment  and  unwilling  to 
return.  Either  the  attitude  assumed  toward  them  was  harsh  and  unsympa- 
thetic, the  examination  was  superficial,  or  some  other  circumstance  arose  to 
arouse  mistrust.  Whatever  the  real  value  of  the  dispensary  is,  it  is  very 
evident  at  present  that  its  efficiency  is  somewhat  distrusted  by  just  those 
people  whom  it  should  reach. 

Such  an  attitude  is  exceedingly  harmful,  and  any  reorganization  that 
would  tend  to  restore  public  confidence  in  the  out-patient  department  is 
much  to  be  desired.  This  particular  investigation  was  undertaken  to  deter- 
mine the  present  effectiveness  of  the  public  dispensaries,  and  to  discover 
means  for  increasing  the  scope  and  improving  the  character  of  their  work. 

Conditions  in  Gouvemeur  Hospital 

Certain  features  of  Gouverneur  Hospital  Out-Patient  Department 
led  to  its  selection  for  investigation:  (i)  the  large  number  (an  average  of 
465  daily)  of  patients;  (2)  the  character  of  patients — conditions  of  pov- 
erty, ignorance,  etc.;  (3)  living  conditions  in  the  section  from  which  it 
draws  its  patients — congestion,  etc.  Such  conditions  would  seem  to  render 
necessary  the  highest  character  of  work  in  an  out-patient  department — 
preventive  and  educational  work.  The  opportunities  for  recognizing  and 
checking  contagious  diseases  and  other  debilitating  sickness  in  an  incipient 
stage  are  numerous  in  this  section,  but  that  such  results  are  not  accom- 
phshed  will  appear  from  the  following  facts. 

In  all  the  clinics  of  Gouverneur  Hospital  that  were  studied — the  Chil- 
dren's ;  the  Gynecological ;  the  General  Medical ;  the  Skin ;  and  the  Ear, 
Nose  and  Throat — it  was  found  that  the  work  in  general  is  hasty  and  un- 
satisfactory. There  are  seven  clinic  rooms  in  all,  and  in  them  are  per- 
formed the  functions  of  eleven  clinics  on  Mondays,  Wednesdays,  and  Fri- 
days, and  eight  on  Tuesdays,  Thursdays,  and  Saturdays.  On  these  former 
days,  therefore,  each  room  must  do  double  or  triple  duty,  in  most  cases 

459 


460  HOSPITAL  COMMITTEE 

with  only  a  few  minutes'  intermission,  so  that  thorough  cleansing  is  im- 
possible, and  the  waste  material  and  odors  remain  from  one  clinic  to  the 
other. 

Of  the  63  doctors  and  surgeons  who  comprise  the  medical  staff  of  the 
Out-Patient  Department,  29,  or  46  per  cent.,  have  their  private  offices  lo- 
cated in  the  neighborhood  of  Gouverneur  Hospital.  The  patients  whom 
they  treat  privately  are  drawn,  in  the  main,  from  the  same  district  as  the 
dispensary  patients. 

Our  investigators  heard  two  of  the  doctors  speak  abusively  to  several 
women  for  coming  to  the  dispensary  instead  of  going  to  the  doctors'  offices. 
One  woman  who  brought  a  very  sick  child  to  the  clinic  was  harshly  or- 
dered out  of  the  room  because  she  wore  earrings,  the  doctor  declaring  that, 
"people  who  wear  diamond  earrings  can  afford  to  go  to  a  private  doctor." 
The  woman  was  deeply  hurt  by  the  repulse,  and  told  our  investigator  that 
the  earrings  were  a  wedding  present  from  her  husband,  and  that  she  had 
worn  them  for  over  twenty  years ;  they  were  not  worth  more  than  two 
dollars,  she  said.  Her  husband  was  striking  at  this  time,  and  she  did  not 
have  enough  money  to  secure  food  for  the  family.  She  left  Gouverneur  to 
seek  entrance  at  another  dispensary,  the  child  being  seriously  ill.  The  doc- 
tors often  refuse  treatment  to  patients,  thus  assuming  a  function  that 
should  properly  be  left  to  administrative  routine.  Many  patients,  4  per 
cent,  of  all  those  investigated,  have  gained  the  impression  that  the  doctors 
harbor  a  feeling  of  resentment  against  them  for  not  patronizing  the  pri- 
vate offices. 

Many  patients  were  admitted  to  the  clinic  rooms  at  the  same  time.  On 
some  occasions  a  room  was  so  crowded  that  the  doctor  had  to  force  his 
way  through  the  standing  patients,  examining  and  prescribing.  One  of  our 
investigators  sat  in  the  room  being  used  as  a  Female  General  Medical  Clinic 
from  10:30  to  12  A.  M.,  on  March  15,  1913,  and  saw  162  patients  treated 
during  that  time  by  two  doctors,  an  average  of  i  minute  and  6  seconds  for 
each  patient.  Of  these,  105  were  new  patients,  of  whom  it  was  necessary 
to  obtain  a  history  of  symptoms,  etc.,  before  prescribing.  In  the  room  used 
as  a  Children's  Clinic  (149  square  feet),  at  the  same  period,  another  in- 
vestigator counted  36  patients  at  one  time.  In  this  group  one  diphtheria 
and  two  scarlet  fever  cases  mingled  with  the  other  children  for  over  thirty 
minutes. 

In  the  majority  of  cases,  as  will  subsequently  be  shown,  there  was  either 
no  physical  examination  before  prescribing,  or  when  it  was  made  it  was 
so  superficial  as  to  be  almost  valueless.  The  doctor  moved  from  patient  to 
patient,  with  a  pencil  and  pad  of  paper  in  his  hands,  asking  a  few  stereo- 
typed questions  and  dispensing  prescriptions  as  rapidly  as  he  could  write 
them.  The  results,  as  will  appear,  were  that  most  patients  received  little 
or  no  relief  from  their  ailments,  and  there  were  frequent  wrong  diagnoses, 
with  a  possibility  of  disastrous  effect. 

There  is  a  distinct  danger,  also,  in  such  a  heterogeneous  crowding  of 
sick  persons.  The  transmission  of  diseases  through  contact  is  made  prob- 
able, especially  in  the  Children's  Clinics,  where  contagious  diseases  are 
common. 

This  danger  of  contagion  is  rendered  more  active  by  conditions  in  the 
waiting-room.  This  room,  containing  1,300  square  feet  (the  area  of  which 
is  decreased  by  the  fixtures  of  25  benches,  Sxiyi  feet  each),  often  holds 
over  200  persons  at  one  time.  In  such  a  crowd,  on  March  11,  1913,  one  of 
our  investigators  observed  two  children,  Molly  S ,  3  years  old,  of  No. 


GOUVERNEUR   OUT-PATIENT  DEPARTMENT  461 

Cherry  Street,  and  Annie  M ,  3^^  years  old,  of  No. Monroe 

Street,  waiting  45  minutes.  The  diagnosis  for  both  was  scarlet  fever.  Dur- 
ing the  time  they  waited  for  examination  these  children  mingled  freely  with 
others,  and  even  after  the  doctor  had  discovered  the  disease  it  was  15  min- 
utes before  they  were  taken  from  the  crowded  room.  There  was  nothing 
to  prevent  this  from  becoming  a  common  occurrence. 

All  cases  of  measles,  whooping-cough,  scarlet  fever,  and  diphtheria  are 
dismissed  with  the  order  not  to  return.  In  the  case  of  the  last  two  ail- 
ments, postal-card  notices,  such  as  are  used  by  private  physicians,  are  sent 
to  the  Department  of  Health.  If  the  address  given  is  false  or  otherwise 
incorrect,  as  very  often  happens,  the  patient  is  never  reached  by  the  Health 
Department  Inspectors  and  remains  without  any  supervision,  a  danger  to 
the  community.  While  the  form  of  notice  which  is  sent  to  the  Department  is 
the  same  as  that  used  by  physicians  in  their  regular  practice,  it  is  made  some- 
what distinctive  by  the  addition  of  the  name  of  the  Hospital  by  means  of  a 
rubber  stamp. 

There  is  on  record  in  the  Gouverneur  Out-Patient  Department,  under 
date  of  January  8,  1913,  the  following  case: 

Chas.   G ,  aged  7  years,  of  No.  Cherry   Street,  which  was 

diagnosed  as  variola  (smallpox)  and  sent  home  without  any  precaution 
against  contagion  except  the  formal  notice  to  the  Health  Department.  An 
Inspector  from  the  Health  Department  visited  this  case  the  following  day 
and  found  that  the  Gouverneur  physician  had  made  a  wrong  diagnosis,  the 
case  being  one  of  chickenpox,  and  not  smallpox.  If  it  really  had  been  the 
latter,  however,  the  extremely  negligent  handling  of  the  case  by  the  Gouver- 
neur officials  would  have  resulted  in  serious  danger  to  the  community.  In 
the  first  place,  the  boy  mingled  with  the  other  children  during  the  time  be- 
fore and  after  examination,  and  when  he  left  the  clinic  there  was  nothing 
to  prevent  him  from  coming  in  contact  with  many  persons  on  his  way 
home,  or  from  spreading  the  disease  among  the  other  members  of  the  fam- 
ily and  in  the  tenement  during  the  time  that  elapsed  before  the  Health  De- 
partment Inspector  came.  In  the  second  place,  the  address  given  might 
have  been  false,  a  very  common  occurrence,  so  that  the  case  would  not 
have  been  reached  by  the  Health  Department  until  smallpox  had  become 
epidemic  in  the  neighborhood. 

That  the  Gouverneur  Out-Patient  Department  method  of  handling  con- 
tagious and  communicable  diseases  probably  results  in  an  increased  num- 
ber of  cases  is  shown  by  the  following  facts : 

Of  40  cases  of  contagious  and  communicable  diseases  (5  diphtheria,  7 
scarlet  fever,  6  chickenpox,  11  whooping-cough,  and  11  measles)  that 
came  to  the  Gouverneur  Out-Patient  Department  during  January,  1913,  and 
were  dismissed  with  the  direction :  "Do  not  come  back  here — go  to  a  doc- 
tor," it  was  found  upon  investigation  at  the  homes  that,  in  6  of  the  whoop- 
ing-cough cases  no  private  doctor  was  called,  and  the  children  were  sick  for 
a  period  of  6  to  10  weeks  each,  without  any  medical  attention,  and  in  two 
instances  the  disease  was  contracted  by  other  members  of  the  family  and 
by  other  families  in  adjoining  flats.  In  3  of  these,  and  in  3  measles,  2 
scarlet  fever  and  2  diphtheria  cases,  the  addresses  given  were  incorrect, 
so  that  the  Health  Department  was  unable  to  reach  them  for  quarantine  or 
fumigation.  What  amount  of  contagion  was  spread  by  these  unsupervised 
cases  cannot  be  determined.  No  private  doctor  was  called  for  any  of  the 
chickenpox  cases,  and  in  two  instances  the  disease  was  communicated  to 
other  families  in  the  same  tenement. 


462  HOSPITAL   COMMITTEE 

The  measles  cases  were  neglected  in  the  same  manner.  In  3  of  the 
cases  that  could  be  reached  by  our  investigators  doctors  were  called  in,  and 
in  the  other  5  no  medical  treatment  was  received. 

Many  complaints  are  made  about  the  pharmacy.  There  is  a  great  deal 
of  delay :  patients  stand  in  line  sometimes  from  i  to  2  hours ;  and  in  addi- 
tion, the  patients  state  that  mistakes  are  frequently  made  in  compounding 
prescriptions.  The  following  case,  supported  by  affidavit,  is  quoted  as  typi- 
cal of  the  complaints  made: 

Case  No.   117.     P.   M ,  boy,  3  years  old,  No.  —   Monroe   Street.     Taken  to 

Gouverneur  O.  P.  D.  by  father  January  4,  1913 ;  doctor  examined  him  and  gave 
prescription  (diagnosis  on  register:  asthma").  Father  had  prescription  filled  at  the 
pharmacy  window  and  went  home.  Immediately  after  taking  a  teaspoonful  of  the 
medicine  according  to  directions  the  child  complained  of  being  burned  by  the 
liquid  and  became  unconscious.  The  father  seized  the  bottle  of  medicine  and  ran 
to  the  Dispensary.  When  he  told  the  porter  what  had  occurred  the  bottle  was 
snatched  from  him  and  he  was  told  that  a  doctor  would  be  sent  to  the  house  at 
once.  When  he  requested  to  have  the  bottle  returned  to  him,  it  was  refused. 
A  Gouverneur  ambulance  arrived  at  his  home  simultaneously  with  himself  and  the 
ambulance  surgeon  administered  an  emetic  which  caused  the  child  to  vomit.  After 
an  hour  of  constant  work  on  the  part  of  the  doctor  the  child  revived.  The  father 
refused  to  permit  the  child  to  be  taken  to  Gouverneur  Hospital  as  the  doctor 
wished  and  has  since  had  him  under  the  care  of  a  private  physician.  The  diagnosis 
for  this  ambulance  case  is  given  in  the  ambulance  record  as  asthma. 

Aside  from  the  mere  lack  of  space  in  the  general  waiting  room  the  ar- 
rangement is  least  economical  for  every  purpose.  One  door  is  used  for 
entrance  and  exit.  Moreover,  the  drug  dispensing  window  is  adjacent  to 
this  same  door,  so  that  there  is  a  continual  thronging  about  this  section  of 
the  room,  while  many  must  wait  outside  until  place  is  made  indoors.  Our 
investigator  counted  64  people  in  line,  reaching  from  the  entrance  on  Water 
Street  around  the  corner  to  the  front  of  the  door.  It  was  raining  hard  on 
this  morning  (March  15,  1913)  and  these  sick  persons  stood  from  15  to  30 
minutes  waiting  for  the  line  to  move  on,  while,  at  the  same  time,  there  was 
sufficient  room  for  them  inside  if  proper  rearrangement  had  been  made. 

When  the  patient  has  entered  he  must  pass  through  the  crowd  of  people 
to  the  middle  of  the  room  where  the  admitting  desk  is  located.  Because 
the  seats  are  not  arranged  with  regard  to  the  crowded  condition  many  pa- 
tients must  stand  until  they  are  admitted  for  treatment,  and  then  continue 
to  stand  for  a  more  or  less  lengthy  period  until  the  prescriptions  are  filled. 
These  crowds  make  it  impossible  for  the  admitting  clerk  to  see  that  every- 
one first  passes  by  his  desk,  and  the  attention  paid  to  records  in  the  clinic 
rooms  is  so  lax  that  it  is  easily  possible  for  patients  to  enter  clinic  rooms 
without  having  been  to  the  admitting  desk.  The  records  kept  by  the  ad- 
mitting clerk  consist  merely  of  cards  representing  the  different  clinics,  and 
a  book  in  which  the  totals  of  new  and  old  patients  are  entered  each  day. 

The  records  of  cases  treated  are  kept  in  books  and,  with  the  exception 
of  the  Gynecological  and  the  Tuberculosis  Clinics,  the  only  information  se- 
cured is  the  name,  age,  address,  and  diagnosis  of  the  patient.  From  these 
records  it  is  impossible  to  determine  whether  or  not  the  patient  ever  re- 
turned for  additional  treatment.  In  one  of  the  Children's  Clinics,  and  in 
the  Nose,  Throat  and  Ear  Clinic  a  nurse  and  a  general  clerk  enter  the 
names,  etc.,  while  in  the  other  clinics  the  doctors  themselves  make  the  en- 
tries. Whenever  a  very  busy  period  occurs  the  records  are  neglected,  so 
that  there  is  hardly  ever  a  complete  recording  of  patients  handled.  As  they 
stand  the  records  are  very  deficient,  since  they  give  no  information  as  to 


GOUVERNEUR    OUT-PATIENT  DEPARTMENT 


463 


the  kind  of  treatment  prescribed  or  the  result  of  such  treatment;  and  it  is, 
therefore,  impossible  to  determine  from  them  whether  or  not  the  patients 
are  being  cured  by  the  Dispensary.  Our  investigation,  in  the  main,  was  an 
attempt  to  satisfactorily  answer  this  last  question — the  efficiency  of  the 
Out-Patient  Department. 

Efficiency  of  Service 

Table  I  shows  the  total  and  average  number  of  visits  per  patient  in  each 
clinic  during  1912.  In  most  of  the  clinics  the  average  is  very  low,  and  this 
would  seem  to  indicate  that  a  great  number  of  cases  came  for  the  initial 
visit,  and  for  various  reasons  failed  to  return  for  additional  treatment. 
Such  averages  as  1.7  visits  per  patient  in  the  Nose,  Ear  and  Throat  Clinic; 
2.1  in  the  Skin;  2.3  in  the  General  Medical;  and  3.7  in  the  Gynecological, 
are  extremely  low,  since  these  clinics  handle  cases  that  can  only  be  bene- 
fited by  continued  treatment.  The  following  table  shows  how  these  figures 
compare  with  those  from  the  St.  Bartholomew  Clinic  of  New  York: 


Clinics 


Average  Number  of  Visits  per 
Patient 


Gouvemeur 

St.  Bartholomew 

2.3 

3.7 

3.7 

6.8 

2.3 

5.3 

6.7 

5.5 

14.3 

2.3 

3.3 

6.7 

*1.7 

4.2 

General  Medical. 
Gynecological .  . . 
General  Surgical. 
Genito-urinary  . . 

Rectal 

Eye 

Ear 

Nose  and  Throat 


*  Ear,  Nose  and  Throat  are  in  one  clinic  ia  Gouvemeur  Hospital. 


This  feature,  and  others  equally  serious,  were  shown  more  clearly  in  the 
group  of  cases  investigated  by  the  inspectors  from  this  Committee.  (Table 
II,  on  page  468.) 

One  thousand  cases  that  came  to  Gouvemeur  during  the  first  two  weeks 
in  January,  1913,  were  investigated.  Because  of  unavoidable  duplication 
this  number  was  later  reduced  to  976.  These  976  cases  consisted  of  499 
from  the  Children's  Clinics  (the  first  499  in  order)  ;  217  from  the  Adult 
General  Medical;  160  from  the  Nose,  Ear  and  Throat;  and  100  from  the 
Gynecological  Clinic.  Every  one  of  these  patients  was  visited  at  the  ad- 
dress given  in  the  Gouvemeur  books  and  information  gathered  regarding 
the  home  and  financial  conditions;  number  of  visits  to  Gouvemeur  Out- 
Patient  Department;  result  of  treatment  and  subsequent  disposition  of  the 
case.  In  459  cases,  47  per  cent,  of  all,  the  patient  could  not  be  found 
at  the  address  given,  because  it  was  false  (that  is,  no  such  number  on  the 
street)  or  otherwise  incorrect. 

Of  the  517  cases  that  were  reached  (Table  II),  it  was  found  that  272, 
or  52.6  per  cent.,  made  only  one  visit  to  Gouvemeur.  Of  these,  121,  or  44.5 
per  cent.,  were  benefited  or  cured  by  the  treatment,  and  151,  or  55.5  per 
cent.,  were  not  benefited.  One  or  more  reasons  accounted  for  the  failure 
to  return  in  each  of  these  151  cases:  11,  or  4  per  cent.,  declared  themselves 


464  HOSPITAL   COMMITTEE 

to  have  been  abused  or  injured  by  the  officials;  85,  or  31.3  per  cent.,  were 
dissatisfied  with  the  character,  or  lack,  of  examination,  and  being  unwilling 
to  trust  to  the  opinion  of  the  Gouverneur  doctors,  went  to  other  dispen- 
saries or,  in  some  cases,  to  private  physicians.  In  16  cases,  or  5.8  per  cent., 
the  patients  were  unable  to  return  because  they  could  not  spare  the  neces- 
sary several  hours  from  household  duties  or  other  work. 

Of  the  245,  or  47.4  per  cent.,  who  made  two  or  more  visits,  75,  or  30.6 
per  cent.,  stated  that  they  had  been  benefited  by  the  treatment;  33,  or  13.4 
per  cent.,  said  they  had  been  cured;  and  137,  or  56  per  cent.,  stated  that 
they  were  not  benefited.  Of  these  latter,  63,  or  25.6  per  cent.,  went  to 
other  dispensaries  or  to  private  physicians,  and  the  remaining  74,  or  30.2 
per  cent.,  were  still  sick  and  without  any  medical  attention. 

In  20,  or  3.8  per  cent,  of  the  total  number  of  cases,  the  patients  were  re- 
ferred to  hospitals.  The  patients  in  73  cases,  or  14. i  per  cent.,  stated  that 
they  had  not  been  examined  by  the  attending  physicians  at  the  time  of  their 
visits  to  the  Out-Patient  Department,  and  had  received  no  benefit  from  the 
medicine  prescribed. 

In  35  cases,  or  6.8  per  cent.,  28  of  which  were  of  children,  the  patients 
became  worse  after  the  visit  to  the  Gouverneur  clinics  and  called  in  pri- 
vate physicians  who,  in  each  case,  stated  that  the  illness  was  different  from 
the  diagnosis  originally  made  at  Gouverneur. 

Many  of  these  wrong  diagnoses  involved  serious  cases  which  might 
have  terminated  fatally  if  additional  medical  aid  had  not  been  secured. 

In  171  cases,  33.1  per  cent,  of  all,  the  conditions  in  the  homes  were  such 
that  the  treatment  given  by  the  Out-Patient  Department  was  unavailing. 
Extremely  unsanitary  living  quarters,  which  aggravated  the  sickness;  ex- 
treme poverty,  which  prevented  the  physician's  directions  from  being  fol- 
lowed ;  ignorance  of  ordinary  preventive  measures ;  other  cases  of  disease 
in  the  family,  some  of  them  communicable,  were  some  of  the  conditions 
which  point  toward  the  need  of  a  "follow-up"  system  to  insure  the  effi- 
ciency of  the  Out-Patient  work. 


The  Work  of  the  Children's  Clinics 

Of  the  304  children  whose  cases  were  investigated  it  was  stated  in  149 
instances,  or  49  per  cent,  of  all,  that  no  benefit  had  been  received.  In  42 
cases,  or  13.8  per  cent.,  the  parents  stated,  that  absolutely  no  physical 
examination  of  the  children  was  made,  prescriptions  being  given  on  the  oral 
description  of  the  cases  by  the  parents.  In  92  cases,  or  30.3  per  cent.,  the 
parents  or  relatives,  distrusting  the  opinion  of  the  clinic  physicians,  went  to 
other  dispensaries  or  called  in  the  services  of  private  physicians.  Twenty- 
eight  cases,  or  9.2  per  cent,  of  all,  were  found  by  private  physicians  to  have 
been  wrongly  diagnosed. 

A  few  of  these  cases  are  quoted  from  the  investigators'  reports : 

Case  No.  19.     G K ,  girl,  6  years.  No.  —  Mangin   St.,  complained  of 

sore  throat  and  was  taken  to   Gouverneur  Out-Patient  Department  Jan.  2.   1913. 

Diagnosis  on  Gouverneur  register,  tonsillitis.     G went  home;   took  medicine  as 

prescribed  by  Gouverneur  physician;  became  worse.     Same  afternoon  mother  called 

in  Dr.  X ,  who  diagnosed  the  case  as  diphtheria.  Health  Department  notified 

and  the  house  was  quarantined.     G — ■ —  was  sick  with  diphtheria  six  weeks. 

Case  No.  72.  I F ,  boy,  2  years.  No.  —  Madison  St  Taken  to  Gouver- 
neur Out-Patient  Department,  Jan.  2,  1913.  Diagnosis  on  register,  bronchitis. 
Mother  gave  the  child  medicine  as  prescribed;   did  not  help  him;   child  became 


GOUVERNEUR    OUT-PATIENT  DEPARTMENT  465 

feverish ;   mother  borrowed   money  and  called   in  Dr.   X ,   who   diagnosed  the 

case  as  pneumonia.     Dr.  X treated  the  child  four  weeks. 

Case  No.  422.    G S ,  boy,  2  years,  No.  —  Madison  St.   Taken  to  Gouver- 

neur  Out-Patient  Department  Jan.  17,  1913,  suffering  from  pain  in  chest.    Diagnosis 

on   register,   bronchitis.     Mrs.   S says   the   doctor   gave   G very   superficial 

examination.    The  medicine  prescribed  did  not  relieve  child  and  Mrs.  S called 

in  Dr.  X ,  who  found  the  patient  in  high  fever  from  pneumonia.     G was 

sick  two  weeks. 

Case  No.  361.    B B ,  boy,  11  years.  No.  —  Montgomery  St.    Had  pains 

in   left    side    of    chest.     Taken   to    Gouverneur    Out-Patient    Department    Jan.    13, 

1913.     Diagnosis    on    register,    bronchitis.      B grew    worse    after    return    from 

Gouverneur;  no  relief  from  medicine.  Mother  thereupon  took  him  to  the  Beth 
Israel  Out-Patient  Department  where  he  was  examined  and  the  disease  diagnosed 
as  empyema.  He  was  referred  to  the  hospital  where  he  was  successfully  operated 
upon  and   discharged  at  the  end  of  three  weeks. 

Case  No.    1187.     S L ,  boy,   14  years.  No.  —  Jackson  St.     S felt 

feverish  and  had  swollen  lips.     Taken  to  Gouverneur  Out-Patient  Department  Jan. 

7,   1913.     Diagnosis  on  register,   stomatitis.     S felt  more   feverish   after   return 

from  Gouverneur  and  medicine  gave  no  relief.  Dr.  Y was  called  in  and  pro- 
nounced it  an  advanced  case  of  scarlet  fever.  Health  Department  was  notified 
and  an  Inspector  came  and  quarantined  the  family.     S was  sick  eight  weeks. 

In  42  cases,  13.8  per  cent,  of  all,  the  parents  stated  that  the  children 
were  not  examined  by  the  physicians  of  the  clinic,  the  parents  having  been 
merely  asked  about  the  condition  of  each  child  and  a  prescription  given. 

There  were  97  cases,  31.9  per  cent,  of  all,  where  the  investigators  found 
conditions  in  the  homes  that  would  militate  against  the  efficiency  of  any 
treatment  that  the  dispensary  could  give.  There  were  cases  that  could  not 
return  for  additional  treatment  because  of  weakness,  or  lack  of  time  on 
the  part  of  the  parents;  extremely  unsanitary  conditions  that  aggravated 
the  disease ;  extreme  poverty  or  ignorance,  so  that  the  directions  of  the  phy- 
sician were  not  followed;  other  cases  of  disease  and  consequent  danger  of 
infection;  and  similar  unfavorable  conditions. 

The  Work  of  the  Adult  General  Medical  Clinics 

Of  the  93  cases  that  were  reached  by  our  investigators,  32,  or  34.4  per 
cent.,  stated  that  they  had  been  benefited  or  cured  by  the  treatment,  and 
61,  or  65.6  per  cent.,  were  not  benefited.  They  reported  as  reasons  there- 
for, lack  of  proper  examination  and  inefficiency  of  treatment.  Of  these  61, 
29  did  not  return  to  the  Out-Patient  Department  after  the  first  visit;  10, 
or  24  per  cent.,  having  gone  to  private  physicians,  and  6,  or  13.4  per  cent., 
to  other  dispensaries,  and  the  other  13  were  still  sick  and  without  any  medi- 
cal attention.  Of  the  32,  or  62.8  per  cent.,  of  those  who  made  two  or  more 
visits  to  Gouverneur  and  were  not  benefited,  15,  or  29.4  per  cent.,  went 
to  other  dispensaries,  and  the  other  13  were  still  sick  and  without  any  medi- 
sick  and  without  any  medical  attention. 

In  21  cases,  or  22.6  per  cent,  of  all,  the  patients  reported  no  physical 
examination  at  first  or  subsequent  visits,  the  diagnosis  and  prescription 
having  been  based  on  the  patient's  response  to  the  question :  "What's  the 
matter  with  you?" 

The  home  conditions  in  27  cases,  28.8  per  cent,  of  all,  were  found  to 
be  such  as  would  interfere  with  the  effectiveness  of  the  treatment  at  the 
Out-Patient  Department.  Severe  illness ;  household  duties,  or  other  work, 
that  made  it  impossible  to  continue  the  visits  to  the  dispensary;  unsanitary 
surroundings  that  aggravated  the  sickness,  particularly  in  lung  and  throat 
diseases ;  infection  and  other  diseases  existing  in  the  same  rooms  with  the 
patient;  etc.,  were  some  of  the  unfavorable  conditions  that  were  found. 


466         •  HOSPITAL  COMMITTEE 

The  ITose,  Throat,  and  Ear  Clinic 

Of  the  yy  cases  that  were  reached  by  our  investigators,  41,  or  53.2  per 
cent.,  did  not  return  after  the  first  visit.  Of  these,  14,  or  34.1  per  cent, 
stated  that  they  had  been  benefited  or  cured  by  the  treatment,  and  27,  or 
65.9  per  cent.,  had  not  been  benefited.  Of  these,  12  had  gone  to  other  dis- 
pensaries or  to  private  practitioners,  and  15  were  still  unwell  and  without 
any  medical  treatment,  and  unable  or  unwilling  to  return  to  Gouverneur.  Of 
those  who  had  made  two  or  more  visits,  21,  or  58.4  per  cent.,  stated  that 
they  had  been  benefited  or  cured  by  the  treatment,  and  15,  or  41.7  per  cent., 
had  not  been  benefited.  Of  these,  4,  or  ii.i  per  cent.,  went  to  other  dis- 
pensaries, and  the  other  11  were  still  unwell  and  without  any  medical  at- 
tention. 

There  were  33  cases,  or  42.9  per  cent,  of  all,  in  which  the  occupation 
of  the  patients  or  their  home  conditions  were  such  as  to  seriously  interfere 
with  the  efficiency  of  the  clinic  treatment. 

The  Gynecological  Clinic 

Of  the  43  cases  from  this  Clinic  that  were  investigated  17,  or  39.5  per 
cent.,  made  only  one  visit  to  the  Clinic.  Of  these,  4,  or  23.5  per  cent., 
stated  that  they  had  been  benefited  or  cured  by  the  treatment,  and  13,  or 
76.5  per  cent.,  had  not  been  benefited.  The  percentage  of  cases  that  had 
made  repeated  visits  and  stated  that  they  had  not  been  benefited  was  still 
greater — 8S.5  per  cent,  of  all  the  cases. 

Comparatively,  there  were  more  complaints  against  this  Clinic  than 
any  of  the  others.  Superficial  physical  examination  and  carelessness  were 
declared  to  be  the  reasons  for  the  lack  of  benefit  from  the  treatment;  in  7, 
or  16.3  per  cent.,  of  the  cases  absolutely  no  physical  examination  of  the 
patient  was  made. 


GOUVERNEUR    OUT-PATIENT  DEPARTMENT 


467 


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468 


HOSPITAL   COMMITTEE 


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2.  SUGGESTIONS  FOR  THE  ORGANIZATION  OF  A  PUBLIC 
OUT-PATIENT  DEPARTMENT 


FOREWORD 

The  findings  of  fact  in  connection  with  the  investigation  of  the  present 
dispensary  of  Gouverneur  Hospital  disclose  a  great  deal  of  wasted  effort 
and  inefficient  treatment  of  patients,  and  the  conclusion  is  reached  that  a 
reorganization  of  the  dispensary  is  necessary  to  secure  satisfactory  results. 
In  this  section  an  effort  has  been  made  to  give  definite  scope  to  this  general 
conclusion.  The  time  and  means  at  our  disposal  have  not  permitted  us  to 
go  into  details  of  organization  and  management  as  thoroughly  as  desired. 
Several  of  the  leading  dispensaries  in  New  York,  Boston,  and  other  cities 
have  been  visited;  their  facilities  and  system  of  operation  studied;  litera- 
ture on  the  subject  has  been  examined;  and  conferences  have  been  held 
with  a  number  of  the  leading  experts  in  dispensary  work,  and  their  criti- 
cisms invited.  Much  valuable  information  has  thus  been  secured.  It  has 
not  been  possible  to  formulate  definite  rules  in  all  cases,  as  dispensary  prac- 
tice has  by  no  means  been  standardized ;  neither  has  it  been  the  aim  to  go 
into  the  refinements  and  technical  details  connected  with  the  operation  and 
management  of  a  large  dispensary  and  suggest  improvements.  An  earnest 
effort  has  been  made  to  merely  outline  a  general  plan  of  organization,  fol- 
lowing what  seems  to  be  the  best  practice  prevailing  at  present  in  the  lead- 
ing dispensaries,  with  due  reference  to  conditions  in  the  public  out-patient 
departments  of  New  York  City. 


471 


THE  OUT-PATIENT  DEPARTMENT  AS  AN  AGENCY  IN  THE 
CARE  OF  THE  SICK 

The  Begiiming  of  Dispensary  Work 

The  out-patient  department  as  a  branch  of  the  New  York  public  hospi- 
tal service  was  first  established  at  Bellevue  Hospital  in  1866,  after  the  mat- 
ter had  been  taken  under  consideration  by  the  Commissioners  of  Public 
Charities  and  Correction  in  1864.  At  that  time  it  seemed  necessary  to  make 
additions  to  the  hospital  service,  and  the  Commissioners  thought  that  the 
establishment  of  an  out-patient  department  would  relieve  the  Hospital  from 
the  treatment  of  a  large  number  of  patients  who  might  be  treated  success- 
fully in  such  a  department.  The  Commissioners  also  thought  that  many 
people  who  suffered  from  diseases  which  did  not  prevent  them  from  pur- 
suing their  usual  vocations,  but  who  were  unable  to  pay  for  the  services  of 
skilled  physicians  and  specialists,  or  for  expensive  medicines,  would  avail 
themselves  of  this  mode  of  relief.  The  successful  operation  of  such  a  sys- 
tem in  Paris  and  London  was  another  important  factor  in  bringing  this  new 
department  into  existence  at  Bellevue  Hospital. 

The  Bureau  of  Medical  and  Surgical  Relief  for  the  Out-Door  Poor 
(the  original  name  of  the  Out-Patient  Department)  was  opened  on  October 
15,  1866.  The  medical  organization  of  this  Bureau  was  not  far  different 
from  the  ordinary  out-patient  department  of  to-day.  It  consisted  of  twenty 
consulting  physicians  and  surgeons.  The  cases  treated  were  classified  as 
follows :  Diseases  of  the  chest ;  diseases  of  women  and  of  children ;  ortho- 
pedic and  general  surgery ;  and  nervous,  urinary,  skin,  eye  and  ear  diseases. 
In  these  various  clinics,  from  the  date  of  opening  to  the  following  January, 
437  patients  were  treated  and  1,378  prescriptions  were  issued.  In  the  sec- 
ond year  of  operation  the  attendance  increased  over  15,000  patients,  justi- 
fying the  step  taken  by  the  Commissioners  to  fill  a  particular  medical  need 
in  the  community. 

The  other  City  hospitals  were  gradually  provided  with  out-patient  de- 
partments, and,  meanwhile,  private  institutions  established  similar  depart- 
ments, generally  of  the  same  kind  as  the  City's.  The  earliest,  probably, 
was  that  of  the  New  York  Hospital  in  1875. 


The  Present  Status  of  the  Dispensary 

The  work  in  connection  with  the  out-patient  department,  though  at  first 
quite  simple,  has  become  more  and  more  complex.  Organized  in  the  be- 
ginning to  give  medical  relief  to  the  sick  poor  who  applied  at  the  dispen- 
sary, and  who  were  not  deemed  in  need  of  hospital  care,  it  has  developed 

473 


474  '  HOSPITAL   COMMITTEE 

many  new  phases  in  different  institutions.  Its  scope  has  gradually  been 
extended  by  the  addition  of  other  clinics ;  and  by  sending  physicians  and 
nurses  to  treat  sick  people  in  their  homes,  to  give  instructions  for  their 
care,  and  to  ascertain  the  causes  of  disease  due  to  environment  or  social 
conditions.  It  has  become  educational  through  dissemination  of  informa- 
tion regarding  the  nature  of  sickness  and  the  means  of  combating  it ;  in- 
structions to  mothers  in  pre-partum  hygienic  measures  and  the  proper 
methods  of  caring  for  infants,  and  other  measures;  and  it  is  aiming  at  pre- 
vention, by  the  treatment  of  incipient  cases  which  might  otherwise  develop 
into  serious  illnesses,  and  by  the  segregation  of  certain  infectious  cases  of 
disease. 

These  and  other  functions  are  not  all  performed  by  any  one  out-patient 
department.  Special  phases  of  the  work  have  been  carried  further  in  some 
institutions  than  in  others,  but  there  is  a  strong  tendency  on  the  part  of 
those  in  charge  of  dispensary  work  to  adopt  those  methods  of  controlling 
disease  which  have  justified  themselves  by  results.  It  is  held  that  treatment 
to  be  effective  must  be  complete ;  that  is,  the  underlying  social  and  en- 
vironmental causes  of  disease  and  its  after  effects  must  be  considered,  as 
well  as  the  specific  illness  itself. 

Along  with  the  widening  of  the  scope  of  dispensary  work  there  has 
been  a  steady  increase  in  attendance.  It  has  recently  been  stated  by  Mr. 
Michael  M.  Davis,  Director  of  the  Boston  Dispensary,  that  fully  three  mil- 
lion persons,  mostly  in  large  cities  of  this  country,  receive  treatment  an- 
nually in  the  out-patient  departments  or  dispensaries.  How  many  treat- 
ments these  represent  can  only  be  estimated.  In  the  annual  report  of  the 
State  Board  of  Charities  for  1910  the  number  of  persons  treated  in  the 
licensed  dispensaries  of  this  State  was  given  as  1,156,701.  Of  this  number 
1,123,457  were  credited  to  New  York  City.  The  total  number  of  treatments 
for  the  State  was  given  as  3,546,729,  of  which  3,415,741  were  credited  to 
New  York  City.  In  the  191 1  report  of  this  Board  the  total  treatments  for 
the  State  were  given  as  2,426,607,  of  which  818,618  were  new  cases.  This 
smaller  number  of  treatments,  as  compared  with  1910,  is  apparently  due 
to  the  fact  that  in  191 1  returns  were  not  included  from  dispensaries  which 
did  not  receive  public  money  for  support.  Many  dispensaries  in  this  City 
treat  from  30,000  to  60,000  patients  per  year,  representing  from  100,000 
to  160,000  treatments  or  more.  Even  if  only  approximately  correct,  allow- 
ing for  duplications  and  other  errors,  these  figures  clearly  indicate  the  im- 
portant place  which  the  dispensary  has  come  to  occupy  in  the  treatment  of 
disease,  especially  in  New  York  City,  and  from  the  point  of  view  of  public 
health,  as  well  as  from  that  of  the  individual  patient,  it  is  of  vast  conse- 
quence that  dispensaries  should  be  well  organized  and  the  work  well  done. 

Notwithstanding  this  extensive  and  importa:nt  work  the  dispensary  has 
received  very  inadequate  appropriation  and  support.  This  may  be  due  in 
part  to  the  fact  that  the  physicians,  who  generally  give  their  services  free, 
have  not  considered  the  dispensary  patient  as  interesting  material  from  the 
clinical  standpoint,  and  many  of  the  best  men,  therefore,  have  declined  ap- 
pointment on  the  dispensary  staff,  or  have  not  attended  the  clinics  regu- 
larly, leaving  much  of  the  work  in  the  hands  of  inexperienced  or  incom- 
petent men.  A  more  important  reason  may  be  sought  in  the  attitude  of 
responsible  authorities,  who  have  failed  to  comprehend  the  importance  of 
dispensary  work,  its  possibility,  and  its  true  social  function,  and  have, 
therefore,  given  to  it  scant  consideration  and  support. 

The  inevitable  result  of  treating  such  a  large  number  of  patients  with 


THE   OUT-PATIENT  DEPARTMENT  475 

inadequate  facilities  and  equipment,  and  with  inadequate  organization,  has 
been  that  a  great  deal  of  very  inferior — not  to  say  criminally  careless — 
work  has  been  done.  The  investigation  into  the  work  of  the  present  out- 
patient department  of  Gouverneur  Hospital  (see  another  section  of  this 
Report,  page  468)  showed  that  from  49  per  cent,  to  76  per  cent,  of  the 
cases  that  required  additional  treatment  did  not  return  after  the  first  visit, 
and  that  from  50  per  cent,  to  88  per  cent,  of  the  cases  that  made  repeated 
visits  had  not  been  benefited.  While  it  is  not  to  be  assumed  that  all  the 
patients  who  come  to  the  dispensary  can  be  cured  or  even  benefited,  the 
facts  disclosed  by  this  investigation  can  lead  only  to  the  conclusion  that  a 
large  percentage  of  the  present  expenditure  for  out-patient  work  in  that 
Hospital  is  entirely  wasted,  or  worse.  The  other  feature,  namely,  the  loss 
to  the  community  through  sickness  and  general  disability  that  might  have 
been  prevented  or  alleviated  by  an  efficient  out-patient  department,  cannot 
be  so  readily  estimated,  but  is  of  still  greater  importance. 

The  ineffectiveness  of  the  work  of  the  Gouverneur  Out-Patient  Depart- 
ment, as  disclosed  by  the  part  of  the  Report  referred  to,  is  due  largely  to 
faulty  organization  and  inadequate  facilities.  Much  of  the  present  waste  of 
money  and  effort  can  be  avoided,  and  should  be.  For  this  purpose  there 
are  set  forth  below  certain  principles  and  practices  to  guide  the  City  in  the 
conduct  and  arrangement  of  its  dispensaries.  It  is  believed  that  they  repre- 
sent the  best  practice  of  the  present  day,  and,  while  not  ideal,  they  will  serve 
as  a  basis  for  future  development. 

The  Function  of  the  Out-Patient  Department 

The  chief  agencies  for  the  care  of  sick  people  are:  (i)  the  hospital; 
(2)  the  dispensary  or  out-patient  department;  and  (3)  district  or  home 
nursing.  The  function  of  the  hospital  is  well  understood;  namely,  the 
treatment  of  serious  cases  of  illness  or  injury — a  treatment  afforded  to 
a  comparatively  small  number  of  people  at  a  relatively  high  cost  by  the 
best  means  known  to  medical  and  surgical  science.  The  district  or  visiting 
nurse  undertakes,  usually  under  the  direction  of  the  family  or  other  physi- 
cian, such  services  as  may  be  needed  by  sick  patients  in  their  homes,  who 
are  not  in  need  of  hospital  care,  or  who  are  unwilling  or  unable  to  go  to  a 
hospital  for  treatment.  Between  these  two  agencies  the  dispensary  occu- 
pies an  intermediary  position. 

The  function  of  the  dispensary  is  described  by  Mr.  Michael  M.  Davis, 
in  the  Boston  Dispensary  Quarterly  for  July,  1913,  as  follows: 

The  special  field  of  the  out-patient  department  or  dispensary  includes,  of  course, 
the  minor  surgical  accidents ;  but  besides  these,  and  in  great  number,  come_  the  in- 
cipient cases  of  illness ;  the  chronic  diseases  which  daily  wear  upon  the  efficiency  of 
the  workingman  or  the  burdened  mother;  the  minor  illnesses  which  will  become 
progressively  more  serious  if  neglected;  the  developmental  defects  of  childhood, 
whose  correction  is  cheap  and  easy  if  taken  in  time,  but  expensive  or  perhaps  impos- 
sible if  deferred.  Acute  and  serious  sickness  also  appears  in  the  out-patient  clinic, 
calling  often  for  reference  of  the  patient  to  a  hospital  or  to  the  care  of  a  physician 
in  bed  at  home. 

The  above  statement  applies  mainly  to  minor  illnesses  and  injuries  suf- 
fered by  poor  people  who  cannot  afford  to  engage  a  private  physician,  but 
Mr.  Davis  calls  attention  to  the  fact  that  the  advance  in  medicine  in  recent 
times  has  created  a  host  of  specialists  for  the  treatment  of  special  diseases, 
such  as  diseases  of  the  eye,  of  the  nose  and  throat,  diseases  of  women  and 
children,  and  many  others.     The  services  of  these  specialists  on  a  paid 


476  HOSPITAL   COMMITTEE 

basis,  he  asserts,  are  beyond  the  reach  of  most  persons  except  the  well-to-do. 
The  dispensary  appears  to  be  the  only  agency  which,  by  proper  organiza- 
tion and  facilities,  can  render  the  services  of  these  experts  available  to  cer- 
tain classes  of  the  population  who  would  otherwise  have  to  do  without 
such  help.  The  dispensary,  therefore,  does  not  solely  concern  itself  with 
the  care  and  treatment  of  the  very  poor. 

The  dispensary  thus  touches  the  work  of  the  hospital  on  one  hand,  and 
on  the  other  joins  with  the  district  nurse  in  alleviating  distress  and  sick- 
ness in  the  home,  but  over  and  beyond  this  there  is  a  wide  field  for  the  dis- 
pensary to  occupy  in  the  prevention  of  disease  by  various  educational  meas- 
ures. Modern  medicine  wisely  lays  emphasis  on  prevention  rather  than 
cure.  The  roots  of  many  cases  of  individual  illness  are  to  be  found  in  so- 
cial and  industrial  conditions  over  which  the  individual  has  little  or  no 
control.  Many  injuries  from  the  use  of  unguarded  machinery  are  obvious 
cases  of  this  kind.  It  is  not  so  evident,  but  nevertheless  true,  that  crowded 
conditions,  unsanitary  plumbing,  and  bad  ventilation  in  the  factory  and 
workshop,  as  well  as  in  the  homes  of  the  poor,  are  predisposing  causes  which 
tend  to  undermine  the  health  and  strength  of  the  worker.  This  condition 
of  impaired  health  brought  about  by  these  causes  is  aggravated  by  poverty, 
in  turn  due,  in  some  measure,  to  seasonal  employment,  and  other  social 
and  industrial  maladjustments.  Ignorance  of  personal  and  family  hy- 
giene, bad  food,  and  worse  cooking,  shiftlessness  and  faulty  habits,  serve 
to  complete  the  general  breakdown.  The  crisis  cannot  be  met  by  the  slen- 
der resources  of  the  individual,  who  is  forced  to  seek  aid  or  go  without 
proper  care  and  treatment,  and,  sooner  or  later,  is  sure  to  become  a  burden 
on  the  community. 

The  City  has  already  assumed  the  function  of  caring  in  part  for  cases 
of  sickness  arising  from  these  factors,  because  of  the  great  danger  and  loss 
to  the  community — not  only  from  contagious  diseases,  but  from  social  in- 
efficiency— of  large  numbers  of  its  people.  The  City  maintains  large  and 
well-equipped  hospitals  for  this  purpose,  and  any  agency  which  promises 
effective  assistance  in  combating  the  evils  of  sickness  and  consequent  de- 
pendency should  receive  adequate  support.  A  comparison  of  hospital  and 
dispensary  cases  is  instructive. 

In  Bellevue  and  Allied  Hospitals  57,422  cases  were  treated  in  1912, 
with  a  total  of  650,154  days  of  treatment.  In  the  out-patient  departments 
of  these  hospitals  153,005  patients  were  treated  during  the  same  year,  with 
a  total  of  418,900  visits.  The  dispensary  patients,  therefore,  outnumber  the 
hospital  patients  about  three  to  one.  In  Gouvemeur  Hospital  alone  4,930 
patients  were  treated  during  1912,  with  64.204  days  of  treatment.  In  the 
out-patient  department  of  that  hospital  60,036  patients  were  treated,  with  a 
total  of  138,432  visits;  that  is,  the  number  of  dispensary  patients  was  more 
than  twelve  times  the  number  of  hospital  patients,  and  the  number  of  dis- 
pensary visits  was  more  than  twice  the  number  of  days  of  treatment  in  the 
Hospital.  The  cost  of  treatment  for  one  day  in  these  hospitals  is  given  as 
about  two  dollars,  and  the  cost  of  a  dispensary  visit  about  ten  cents. 

It  must  not  be  assumed  that  all  hospital  cases  are  serious  cases,  requir- 
ing prolonged  treatment.  Of  those  admitted  to  Bellevue  Hospital,  3,884 
were  patients  in  the  psychopathic  ward,  most  of  whom  were  discharged 
after  a  few  days'  observation  to  a  hospital  for  the  insane.  There  were 
also  admitted  8,860  alcoholics,  and  of  these,  55  per  cent,  remained  less  than 
5  days.  A  study  of  other  cases  discharged  from  Bellevue  Hospital  during 
1912  as  "cured"  or  "improved"  showed  that  a  large  number  of  the  cases 


THE   OUT-PATIENT  DEPARTMENT  477 

remained  for  a  very  short  time  only,  and  very  probably  were  not  true  hos- 
pital cases.  Of  5,159  patients  who  left  the  medical  service  with  the  author- 
ization of  the  house  physician  as  having  been  "cured"  or  "improved,"  65 
were  discharged  on  the  day  of  admission ;  394  on  the  day  following  admis- 
sion; and  461  on  the  third  day.  In  other  words,  920  patients,  or  17.1  per 
cent,  of  all  discharges  from  this  service,  were  in  the  Hospital  3  days  or  less 
from  the  day  of  admission.  Of  6,269  patients  who  were  discharged  from 
the  surgical  service  as  having  been  cured  or  improved,  151  were  discharged 
on  the  day  of  admission;  741  were  discharged  on  the  day  following;  and 
522  left  on  the  third  day.  That  is,  1,414  patients,  or  22.5  per  cent,  of  all 
of  the  discharged,  were  in  the  Hospital  for  3  days  or  less.  In  the  gyneco- 
logical service  the  average  length  of  stay  is  somewhat  greater,  but  here, 
also,  there  was  a  considerable  amount  of  short  period  discharges.  Of  1,476 
patients  discharged  as  "cured"  or  "improved,"  8  were  discharged  on  the  day 
of  admission ;  128  on  the  following  day ;  and  70  on  the  third  day.  Two  hun- 
dred and  sixteen,  or  14  per  cent,  of  all  the  discharges,  were  within  3  days 
of  the  date  of  admission.  In  the  genito-urinary  service  30.3  per  cent,  of  all 
of  the  discharges  were  in  the  Hospital  3  days  or  less.  According  to  the 
records,  45  were  "cured"  or  "improved"  on  the  day  of  admission;  370  on 
the  day  following  admission ;  and  200  on  the  third  day. 

These  facts  serve  to  show  the  advantage  of  a  close  coordination  be- 
tween the  out-patient  department  and  the  hospital  with  which  it  is  affiliated. 
Doubtless  many  of  these  short  time  patients,  requiring  treatment  for  a 
brief  period,  or  observation  to  determine  diagnosis,  were  proper  hospital 
cases,  but  it  seems  quite  obvious  that  many  of  them  were  not — genito- 
urinary and  gynecological  cases  serious  enough  to  require  admission  to  a 
hospital  can  hardly  be  cured  within  3  days  from  the  date  of  admission,  and 
certainly  not  within  a  few  hours.  A  close  coordination  of  the  hospital 
with  an  out-patient  department  organized  to  treat  patients  of  this  kind 
would  relieve  the  hospital  from  the  necessity  of  handling  many  of  these 
cases.  In  addition,  there  are  many  patients  now  being  discharged  before 
their  condition  really  warrants  it,  in  order  to  make  room  for  more  urgent 
cases.  The  discharge  of  such  patients  could  be  properly  made  if  they 
could  be  transferred  to  an  out-patient  department  for  supervision  and 
occasional  treatment  and  advice  during  the  period  of  convalescence.  A 
closer  correlation  of  the  work  of  the  hospital  and  dispensary  would  enable 
the  hospital  to  treat  a  larger  number  of  more  serious  cases,  and  it  would  be 
much  more  economical  for  the  City,  as  a  day's  treatment  in  a  hospital 
costs  about  two  dollars,  and  adequate  treatment  in  a  dispensary  can  be  fur- 
nished for  about  one-tenth  of  that  amount  per  visit.  There  has  been  some 
cooperation  between  the  hospital  and  dispensary  in  the  past,  but  it  has  not 
been  developed  so  far  as  it  should  be.  Suggestions  along  this  line  are 
made  in  the  pages  on  "Organization." 

The  enormous  attendance  at  many  of  our  leading  dispensaries  has  fre- 
quently been  cited  as  proof  of  the  widespread  abuse  of  dispensary  privi- 
leges on  the  part  of  people  who  can  afford  to  pay  for  medical  services. 
It  is  more  than  doubtful  if  there  is  much  to  sustain  this  view.  At  a  recent 
convention  of  the  American  Hospital  Association  in  Boston  the  President  of 
the  Association  vigorously  expressed  the  opinion  that  this  alleged  dispensary 
abuse  did  not  deserve  much  consideration.  Many  other  experts  in  dis- 
pensary work  are  of  the  opinion  that  the  term  "dispensary  abuse"  ought  to 
be  construed  to  mean  abuse  of  patients  on  the  part  of  the  dispensary,  and 
not  abuse  of  dispensary  privileges  on  the  part  of  patients.     This  conten- 


478  HOSPITAL  COMMITTEE 

tion  is  strongly  supported  by  the  facts  disclosed  in  the  investigation  of 
Gouverneur  Hospital.     (Page  459.) 

It  is  open  to  question  whether  a  public  dispensary  should  be  entirely 
free,  or  whether  a  nominal  fee  should  be  charged,  and  if  so,  how  much. 
It  seems  only  fair  to  protect  the  private  physician  who  gives  his  services 
free,  or  for  a  nominal  remuneration,  by  refusing  admission  and  treatment 
to  those  who  can  afford  to  pay  for  medical  service.  The  usual  fee  now 
charged  in  many  dispensaries  is  ten  cents  per  visit,  which  does  not  begin 
to  cover  the  expenses  of  an  adequately  organized  out-patient  department. 
Two  of  the  leading  dispensaries  in  Boston  have  recently  advanced  the  fee 
for  adult  patients  to  twenty-five  cents  for  the  first  visit,  and  ten  cents  for 
each  subsequent  visit.  In  special  clinics  the  charge  is  greater,  varying  with 
the  nature  of  the  service.  In  the  eye  clinic  of  one  of  these  dispensaries  the 
charge  for  the  first  visit  is  one  dollar,  and  for  each  subsequent  visit  fifty 
cents.  The  aim  is  to  place  this  clinic  on  a  self-supporting  basis,  compen- 
sating the  medical  service,  and  yet  meeting  the  need  of  those  who  are 
willing  to  pay  something,  but  are  unable  to  pay  the  regular  fee  of  a  skilled 
oculist.  Arrangement  is  also  made  to  give  treatment  to  those  who  cannot 
afford  to  pay  anything. 

The  adoption  and  faithful  observance  of  such  a  policy  would  serve  to 
reduce  to  a  minimum  the  improper  use  of  dispensary  privileges.  An  experi- 
enced admitting  officer  can  readily  detect  the  more  flagrant  cases,  and  the  sus- 
picious ones  are  open  to  investigation  through  the  Social  Service  Depart- 
ment or  other  means.  It  would  also  seem  advisable  to  bring  about  a  dis- 
tricting of  the  City  along  the  line  of  the  Associated  Tuberculosis  Clinics, 
assigning  a  certain  district  to  each  of  the  leading  dispensaries.  This  would 
promote  efficient  investigation,  and  help  to  deter  those  applying  for  treat- 
ment who  could  afford  the  services  of  a  private  physician. 

In  regard  to  the  pauperization  of  those  receiving  free  benefactions,  it 
must  be  said  that  there  is  an  important  distinction  between  the  rendering 
of  medical  service  and  the  bestowal  of  material  goods.  There  is  some  rea- 
son in  the  argument  that  free  gifts  of  food  and  clothing  increase  depen- 
dence, since  the  individual  should  be  able  to  provide  sustenance  and  shelter 
for  himself  and  his  family.  Anyone  who  cannot  do  this  is  rightly  consid- 
ered a  failure,  but  this  does  not  apply  to  cases  of  disease.  Sickness  and 
injury  are  often  due  to  causes  beyond  the  control  of  the  individual,  and 
the  family  budget  that  is  just  adequate  to  provide  for  the  necessities  of  life 
has  no  margin  for  the  proper  treatment  of  disease.  A  family  of  six  may 
be  independent  on  an  income  of  $12  or  $15  a  week  and  yet  would  not  be 
able  to  meet  the  added  expense  of  sudden  sickness.  The  City's  free  medi- 
cal service  would  not  break  down  the  independence  of  such  a  family; 
rather  it  prevents  dependence  while  removing  the  cause  and  re-establish- 
ing the  family  on  a  self-supporting  basis.  It  can  hardlybe  asserted  that  the 
family  would  relapse  into  dependence  by  wilfully  inviting  sickness,  and  so 
far  as  free  medical  service  safeguards  the  community  and  promotes  social 
efficiency,  it  is  a  legitimate  part  of  municipal  expenditure. 

Social  Service 

Social  service  work  in  connection  with  hospitals  and  out-patient  de- 
partments has  been  a  development  of  recent  years.  In  her  forthcoming 
book  on  Social  Work  in  Hospitals,  published  by  the  Russell  Sage  Founda- 
tion,  Miss  Ida  M.  Cannon,  of  the  Massachusetts  General  Hospital,  de- 


THE   OUT-PATIENT  DEPARTMENT 


479 


scribes  several  forms  of  social  service  work,  beginning  with  the  after-care 
of  the  insane  in  England  in  1880.  These  "expressions  of  social  interest," 
as  she  calls  them,  differ  from  social  work  as  we  now  know  it,  and  which 
had  its  beginning  in  Boston  in  1905,  when  Dr.  Richard  Cabot,  for  the  pur- 
pose of  improving  dispensary  service,  introduced  the  social  worker  as  a 
means  of  securing  a  more  accurate  diagnosis  and  rendering  more  effective 
treatment.  The  idea  was  soon  adopted  by  Bellevue  and  other  leading  hos- 
pitals and  dispensaries  in  this  City  and  elsewhere,  and,  notwithstanding 
objections  raised,  a  well-organized  social  service  department  is  more  and 
more  considered  a  necessary  adjunct  in  rendering  effective  medical  service. 
Social  service  finds  its  justification  in  the  interdependence  of  social  and 
medical  diagnosis.  The  physician  seeks  to  ascertain  the  nature  of  the  ill- 
ness of  the  patient  and  its  cause  as  best  he  can,  and  prescribes  treatment, 
but  he  cannot  go  beyond  the  examination  of  the  patient  and  investigate  the 
social  cause  of  the  ailment,  whether  due  to  family  or  home  conditions,  to 
the  nature  of  his  employment,  or  other  causes.  For  this  information  he  is 
dependent  upon  the  skilled  social  worker,  and  in  her  absence  his  prescrip-. 
tion  might  be  valueless,  although  the  diagnosis  was  correct.  An  illustra- 
tion taken  from  Miss  Cannon's  book  will  make  this  clear: 

A  nervous  little  girl  of  fifteen  was  once  referred  by  a  neurologist  to  a  social 
service  department  with  the  request  that  she  be  sent  to  a  class  for  stammerers. 
A  teacher  of  articulation  had  told  the  neurologist  that  he  would  gladly  take  some 
patients  in  his  Saturday  afternoon  class.  Realizing  the  social  and  economic  handi- 
cap of  her  affliction,  she  stammered  out  her  appreciation  of  this  opportunity,  which 
was  all  the  better  because  it  would  not  interfere  with  her  working  time.  A  talk 
with  the  patient  and  a  visit  to  the  home  revealed  the  fact  that  this  anemic,  nervous 
girl  was  working  nine  hours  a  day  in  a  net  and  twine  factory,  where  her  fingers 
were  flying  every  moment ;  that  daily  she  walked  a  mile  to  her  work  and  a  mile 
back;  and  that  at  the  end  of  the  day  she  returned  to  cold  rooms  and  to  entirely 
inadequate  food,  improperly  prepared.  The  mother,  a  prematurely  old  widow  with 
two  daughters,  worked  all  day  in  a  factory — though  she  was  entirely  unfit  for  it — 
and  had  no  strength  after  her  work  to  attend  to  the  physical  needs  of  her  family. 
The  total  income  of  the  family  was  eight  dollars  a  week.  Through  the  effort  of 
the  social  service  department,  the  church  and  a  relief  agency  were  called  upon  to 
supplement  the  income  and  the  patient  was  sent  away  for  several  months'  rest. 
After  a  year  of  watchful  oversight  the  social  worker  succeeded  in  bringing  the 
patient  to  the  condition  where  she  was  fit  to  have  the  training  in  speech. 

It  is  obvious  that  cases  of  this  character  require  the  services  of  a  social 
as  well  as  a  medical  diagnostician.  It  is  not  sufficient  to  offer  medical  aid 
in  the  clinic  rooms  if  there  are  conditions  in  the  homes  of  the  patients  that 
militate  against  the  effectiveness  of  dispensary  treatment.  The  social  ser- 
vice worker  must  be  called  in  to  supply  the  necessary  information  upon 
which  successful  treatment  can  be  based. 

In  the  investigation  of  the  work  of  the  Gouverneur  Out-Patient  De- 
partment it  was  found  that  from  50  per  cent,  to  88  per  cent,  of  the  patients 
did  not  return  to  complete  the  treatment  which  they  had  begun.  A  large 
part  of  the  effort  thus  wasted  was  due  to  the  inefficiency  in  the  operation  of 
the  Out-Patient  Department  itself,  but  there  were  other  factors,  such  as 
ignorance  on  the  part  of  the  patients,  physical  inability  to  return,  and  un- 
wholesome sanitary  surroundings,  which  prevented  successful  treatment. 
An  efficient  social  service  bureau  undoubtedly  could  have  prevented  a  great 
deal  of  this  wasted  effort,  as  is  shown  by  the  following  comparison  be- 
tween the  work  of  the  Gouverneur  and  the  Presbyterian  Out-Patient  De- 
partments, which,  in  the  latter  institution,  has  a  well-organized  social 
service  bureau,  with  visiting  nurses,  as  part  of  its  work.     One  hundred 


48o 


HOSPITAL  COMMITTEE 


cases  were  taken  at  random  from  the  files  of  the  Presbyterian  Out-Patient 
Department  and  investigated  in  the  homes  by  agents  of  your  Committee. 
These  were  cases  in  which  patients  did  not  benefit  by  the  dispensary  treat- 
ment and  were  referred  by  the  cHnic  doctors  to  the  social  service  bureau 
for  investigation.  In  83  of  the  cases  the  patients  were  either  benefited  or 
cured  by  the  combined  medical  and  social  service,  and  in  17  cases  the  bene- 
fit was  not  apparent.  In  13  of  the  83  cases  extra  assistance,  in  shape  of 
food,  clothing,  or  removal  to  a  more  favorable  place  for  convalescence, 
was  given  to  make  efifective  the  medical  treatment. 

A  few  of  these  cases  from  the  Presbyterian  Out-Patient  Department 
are  compared  below  with  other  cases  taken  from  your  Committee's  investi- 
gation of  the  Gouverneur  Out-Patient  Department.  While  the  cases  are 
not  precisely  similar,  they  are  enough  alike  in  character  of  disease  and 
home  conditions  to  warrant  the  supposition  that  a  result  similar  to  that  of 
the  Presbyterian  Hospital  might  have  been  obtained  in  the  Gouverneur  dis- 
pensary with  the  aid  of  an  efficient  social  service  department. 


Gouverneur    Out-Patient   Department. 

Annie   S ,   7  years,   No.  —   Cherry 

Street.  Very  delicate,  sickly  child;  has 
been  so  ever  since  birth.  Taken  to  Out- 
Patient  Department  January  11,  1913. 
Diagnosis  :  chorea.  Made  two  subsequent 
visits.  Has  not  been  benefited  by  treat- 
ment. Is  still  very  weak;  no  appetite. 
The  hygienic  condition  of  home  very 
bad.  There  are  3  other  children,  all 
weakly.  Father  earns  from  $7  to  $9  per 
week;  is  unable  to  secure  the  treatment 
which  Annie  needs. 


Gouverneur   Out-Patient   Department. 

Geo.   S ,  2  years.   No.  —  Madison 

Street.  Had  fever  and  bad  cough.  Was 
taken  to  Out-Patient  Department  Jan- 
uary 17,  1913.  Doctor  superficially  ex- 
amined patient.  Diagnosis :  bronchitis. 
Patient  grew  worse.  Mother  took  patient 
to  private  physician,  who  diagnosed 
pneumonia.  Hygienic  condition  of  home 
extremely  bad ;  personal  habits  of  mother 
careless.  Treatment  of  patient  at  home 
unsatisfactory. 


Gouverneur    Out-Patient   Department. 

Celia    P ,    12    years.    No.    —    Pitt 

Street.     Troubled   with   diseased   tonsils. 
Taken  to  Out-Patient  Department  Janu- 


Presbyterian  Out-Patient  Department. 

Minnie  J ,  11  years,  No.  —  E.  8ist 

Street.  Very  nervous  and  unruly. 
i\lother  has  4  other  children  to  take 
care  of ;  could  not  attend  to  patient 
Taken  to  Out- Patient  Department  March 
iS,  1913.  Diagnosis :  chorea.  Not  bene- 
fited. Subsequent  visit  March  25th,  1913. 
Referred  by  doctor  to  Visiting  Nursing 
Department.  Nurse  visited  home  March 
26th.  Put  patient  to  '  bed ;  administered 
medicine  according  to  doctor's  prescrip- 
tion; observed  progress  of  patient's  con- 
dition, and  advised  as  to  diet  and  treat- 
ment. Patient  did  not  improve,  and  upon 
nurse's  suggestion  mother  brought  pa- 
tient to  Presbyterian  Hospital  April  8th. 
Discharged  May  29th  improved.  Sent 
to  country  by  Social  Service  Department 
to  complete  convalescence. 

Presbyterian  Out-Patient  Department. 

Josephine   O ,   4   years,    No.   —   E. 

77th  Street.  Was  feverish  and  had  sore 
throat.  Taken  to  Out-Patient  Depart- 
ment April  14,  1913.  Diagnosis :  bron- 
cho-pneumonia. Case  referred  to  Visit- 
ing Nursing  Department  for  observa- 
tion and  treatment.  Visiting  nurse  called 
April  isth ;  took  temperature ;  applied 
mustard  plaster;  and  instructed  mother 
to  keep  patient's  mouth  and  tongue  clean. 
Called  again  April  i6th ;  found  patient 
fretful  and  irritable;  condition  unim- 
proved. Advised  mother  to  take  child  to 
Hospital.  Patient  admitted  to  Hospital 
and  after  6  days  stay  was  dismissed 
cured. 

Presbyterian  Out-Patient  Department. 

George  F ,  7  years,  No  —  E.  98th 

Street.  Had  swollen  tonsils.  Taken  to 
Out-Patient    Department    November    30, 


THE   OUT-PATIENT  DEPARTMENT 


afy  7>  I9I3'  Diagnosis :  follicular  tonsil- 
litis. Doctor  of  Out-Patient  Department 
directed  patient  to  stay  in  bed.  Made 
two  subsequent  visits  to  Out-Patient  De- 
partment, but  condition  of  patient  still 
very  bad.  School  doctor  said  patient 
must  have  tonsils  cut;  possibility  of  de- 
veloping consumption;  child  unruly  and 
irritable.  Mother  is  helpless  and  cannot 
induce  her  to  undergo  the  necessary 
operation.  Sanitary  condition  of  build- 
ing extremely  bad.  Family  consists  of  2 
adults  and  3  children;  living  in  3  small, 
semi-dark  rooms;  unclean  condition.  Pa- 
tient has  no  father  and  family  is  assisted 
in  paying  rent  by  United  Hebrevsr  Qiari- 
ties. 


igi2.  Diagnosis :  tonsillitis.  Doctor  of 
Out-Patient  Department  referred  case  to 
Visiting  Nursing  Department  with  direc- 
tions to  nurse  to  demonstrate  use  of 
gargle.  Visiting  nurse  called  Novem- 
ber 30th,  showed  patient  how  to  gargle 
and  took  temperature.  She  made  3  more 
visits  and  advised  patient  to  go  again  to 
Dispensary  for  further  examination  by 
doctor.  Nurse  called  again  after  pa- 
tient's visit  to  Dispensary.  Noticed  that 
patient's  brother  had  3.  sore  throat.  He 
also  was  made  to  gargle  with  brother's 
medicine.  Visiting  nurse  obtained  two 
free  tickets  admitting  both  brothers  to  a 
special  nose,  ear  and  throat  dispensary 
to  have  their  tonsils  cut.  Social  Service 
Department  of  Presbyterian  Hospital 
supplied  family  with  milk  during  the  pe- 
riod of  patients'  illness.  Patients  now 
improved;  waiting  for  opportunity  to 
have  tonsils  removed. 

GOUVEENEUR     OuT-PaTIENT     DEPARTMENT.         PRESBYTERIAN   OuT-PaTIENT  DEPARTMENT. 


Izzy    F ,    5    years,    No.    —    Henry 

Street.  A  weak,  underfed  and  anemic 
child.  Had  a  harsh  cough.  Taken  to 
Out-Patient  Department  January  9,  1913. 
Diagnosis :  laryngitis.  Was  given  medi- 
cine. Patient  was  not  relieved  and  re- 
ceived no  further  medical  attendance. 
The  family  subsists  on  $5-6  per  week; 
mother,  and  baby,  6  months  old,  look 
half-starved;  father  has  weak  heart. 
The  home  is  filthy;  sanitary  condition  of 
building   extremely   bad. 


Sam   D ,  6  years,   No.   —   E.   66th 

Street.  Was  coughing.  Taken  to  Out- 
Patient  Department.  Diagnosis :  laryn- 
gitis. Doctor  of  Out-Patient  Depart- 
ment referred  case  to  Visiting  Nursing 
Department  for  treatment.  Visiting  nurse 
called  January  29,  1913.  Demonstrated 
to  patient  use  of  steam  inhalation;  called 
again  January  30th  and  advised  mother 
to  take  patient  to  Dispensary  for  final 
examination.  Patient  taken  to  Dispen- 
sary, examined  and   dismissed  improved. 


GOUVERNEUR     OuT-PaTIENT     DEPARTMENT.         pRESBYTERIAN   OuT-PaTIENT  DEPARTMENT. 


Mamie  Y ,  3  years.  No.  —  Cherry 

Street.  Coughs  and  has  defective  ton- 
sils. Was  taken  to  Out-Patient  Depart- 
ment on  January  7,  1913.  Diagnosis : 
tonsillitis.  Doctor  advised  patient's 
mother  to  see  that  child's  tonsils  be  re- 
moved. Made  11  subsequent  visits  to 
Out-Patient  Department ;  was  given  medi- 
cine each  time.  Mamie's  condition  has 
not  improved.  The  home  lacks  cleanli- 
ness and  ventilation;  3  small,  dark  rooms. 
Family  income  $11  per  week;  2  minors 
to  be  supported. 

Gouverneur    Out-Patient   Department.      Presbyterian  Out-Patient  Department. 


Marion  S ,  2  years.  No.  —  E.  73d 

Street.  Had  swollen  tonsils.  Was 
taken  to  Out-Patient  Department  May 
6,  1913.  Diagnosis :  tonsillitis.  Doctor 
referred  case  to  Visiting  Nursing  Depart- 
ment for  further  treatment.  Visiting 
nurse  called  May  7,  1913;  examined  pa- 
tient's throat;  took  the  temperature  and 
administered  medicine.  Made  4  subse- 
quent visits  and  dismissed  case  im- 
proved. 


Benj.  B ,  11  years,  No.  —  Mont- 
gomery Street.  Had  a  cough  and  pain 
in  left  side.  Taken  to  Out-Patient  De- 
partment January  13,  1913.  His  throat 
was  examined.  Diagnosis :  bronchitis. 
Patient's  condition  became  worse.  Called 
again  at  Out-Patient  Department;  was 
given  medicine,  but  was  not  relieved. 
Mother  took  him  to  Beth  Israel  Dispen- 
sary, where  doctor  diagnosed  empyema 
and  said  patient  is  to  undergo  an  opera- 
tion immediately.     Patient's  father  is  af- 


Mary  L ,  9  months.  No.  — ■  E.  7Sth 

Street.  Had  a  cough  and  fever.  Taken 
to  Out-Patient  Department  February  22, 
1913.  Diagnosis :  broncho-pneumonia. 
Doctor  of  Out-Patient  Department  re- 
ferred case  to  Visiting  Nursing  Depart- 
ment for  observation  and  treatment. 
Visiting  nurse  called  February  22,  1913; 
gave  patient  alcohol  sponge;  took  tem- 
perature, etc.  Made  2  more  visits.  Con- 
dition of  patient  _  uninrproved.  Nurse 
suggested  that  patient  be  sent  to  Hos- 


HOSPITAL   COMMITTEE 


pital.  Mother  refused  to  do  so,  but  in- 
stead called  in  a  private  physician  who 
treated  patient.  Visiting  nurse  continued 
daily  visits  from  February  25th  to 
March  15th,  when  patient  was  dismissed 
improved    to    Dispensary. 

Presbyterian  Out-Patient  Department. 

Catherine    F ,    7   years,    No.    —    E, 

75th  Street.  Suffering  from  weak  heart. 
Taken  to  Out-Patient  Department  March 

18,  1913.  Diagnosis :  valvular  disease  of 
heart.  Doctor  of  Out-Patient  Depart- 
ment referred  case  to  Visiting  Xursing 
Department.    Visiting  nurse  called  Alarch 

19,  1913-  Investigated  living  conditions 
of  patient ;  applied  ice  bag  on  patient's 
heart,  and  told  her  to  remain  in  bed. 
Visiting  nurse  made  3  more  visits ;  in- 
structed patient  how  to  take  care  of 
herself.  Dismissed  case  improved  to  Dis- 
pensary. 

GOUVERNEUR     OuT-PaTIENT     DEPARTMENT.         PrESBYTEEIAN   OuT-PaTIENT  DEPARTMENT. 

Theresa  M ,  3  years.  No.  —  E.  69th 

Street.  Had  pains  in  throat.  Taken  to 
Out-Patient  Department  February  19, 
1913.  Diagnosis :  acute  follicular  tonsil- 
litis. Case  referred  to  Visiting  Nursing 
Department  for  attendance  and  treatment. 
Visiting  nurse  visited  home  February  20, 
1913.  Investigated  living  conditions  of 
patient;  irrigated  throat  and  took  tem- 
perature. On  second  visit  taught  patient 
how  to  gargle.  Visiting  nurse  made  3 
subsequent  visits.  Condition  of  patient 
much  improved.  Dismissed  case  to  Dis- 
pensary February  24,  1913,  improved. 


flicted  with  tuberculosis ;  is  not  receiv- 
ing any  medical  attention.  Mother  ig- 
norant and  careless,  and  has  no  concep- 
tion of  the  danger  of  tuberculosis  infec- 
tion. Two  adults  and  6  children  are 
occupying  3   small   rooms. 

GOUV'ERNEUR     OuT-PaTIENT     DEPARTMENT. 

Mollie  J ,  10  years,  No.  —  Mont- 
gomery Street.  Has  trouble  with  heart. 
Taken  to  Out-Patient  Department  Janu- 
ary 22,  1913.  Was  examined ;  no  diagno- 
sis. Medicine  did  not  help  her.  Is  very 
weak  and  anemic.  There  are  2  or  more 
cases  of  tuberculosis  in  family.  Hygi- 
enic condition  of  home  extremely  bad. 
Three  dark  rooms  in  basement  filled  with 
old  filthy  garments.  Income  uncertain; 
extreme  want  and  poverty. 


Isidor  F ,  7  years.  No.  —  Monroe 

Street.  Had  swollen  tonsils.  Taken  to 
Out-Patient  Department  January  24, 
1913.  Diagnosis:  tonsillitis.  Was  given 
medicine ;  not  benefited.  Called  again  at 
Out-Patient  Department  and  given  more 
medicine.  Sick  in  bed  lYz  weeks,  during 
which  time  received  no  medical  treat- 
ment. Child's  tonsils  still  very  painful. 
Father  and  mother  rag-peddlers ;  income 
uncertain.  There  is  no  one  to  take  care 
of  home  and  children.  Floor  covered 
with  rags  and  dirt  of  every  description. 
Two  adults  and  s  children  live  in  3 
rooms ;  2  absolutely  dark. 

Gom'ERNEUR    Out-Patient   Department.      Presbyterian  Out-Patient  Department. 


Sarah  F ,  8  months.  No.  —  Gouver- 

neur  Street.  Had  heavy  cold  and  stom- 
ach disturbance.  Taken  to  Out-Patient 
Department  January  7,  1913.  Diagnosis: 
bronchitis.  Given  tablets  to  clear  stom- 
ach. Patient  did  not  improve.  Taken 
again  to  Out-Patient  Department,  but  re- 
ceived no  relief.  Baby  still  suflters  from 
constipation,  is  losing  weight  and  is  gen- 
erally very  weak.  Family  consists  of 
3  adults  and  child,  living  in  4  dark  rooms. 
No  proper  ventilation ;  lack  of  cleanliness. 


Gouverneur   Out-Patient  Department. 

Dave  Z ,  6  months,  No.  —  Cherry 

Street.      Had    serious    stomach    disturb- 
ance.    Taken  to  Out-Patient  Department 


Alice  C ,  13  months.  No.  —  E.  85th 

Street.  Had  cough  and  stomach  disturb- 
ance. Taken  to  Out-Patient  Department 
July  19,  1913.  No  diagnosis.  Case  re- 
ferred to  Visiting  Nursing  Department 
for  treatment.  Visiting  nurse  called 
July  20,  1913 ;  investigated  home  condi- 
tions ;  advised  mother  as  to  proper  ventil- 
ation; prepared  patient's  food,  and  ob- 
tained eggs  and  baby  clothes  for  patient 
from  Social  Service  Department  of  Pres- 
byterian Hospital.  Continued  visits  up 
to  September  12,  when  patient  was  sent 
to  Presbyterian  Hospital  for  treatment. 
Discharged  from  Hospital  October  24th; 
patient  had  whooping-cough.  Visiting 
nurse  resumed  visits  and  on  January  8, 
1913,  patient  was  dismissed  to  Dispensary 
improved. 

Presbyterian  Out-Patient  Department. 

Raymond  A ,  13  months,   No.  

E.  78th  Street.  Was  taken  ill  with  stom- 
ach  disturbance.     Taken   to   Out-Patient 


THE   OUT-PATIENT  DEPARTMENT  483 

January  3,  1913.  Diagnosis:  entero-co-  Department  February  18,  1913.  Diagno- 
litis.  Made  2  subsequent  visits;  was  not  sis:  entero-colitis.  Case  referred  to  Vis- 
benefited;  sick  3  weeks.  Patient's  ear  is  iting  Nursing  Department  for  treatment, 
in  a  diseased  condition;  is  not  being  Visiting  nurse  called  daily  from  Febru- 
treated.  Home  lacks  cleanliness  and  ary  18  to  March  3,  1913.  Made  irriga- 
proper  ventilation.  Mother  ignorant  as  tions,  prepared  food  and  carefully 
to  diet  and  general  care  of  baby.  watched  condition  of  patient.     The  baby 

failed  to  improve.  Visiting  nurse  ad- 
vised mother  to  take  child  to  Hospital. 
Patient  admitted  to  Hospital  March  3, 
1913,  and  dismissed  improved  March  17, 
1913. 

It  is  apparent  from  the  foregoing  that  there  are  numerous  cases  of  sick- 
ness which  cannot  be  relieved  merely  by  the  treatment  offered  in  the  cHnic, 
no  matter  how  excellent  it  may  be.  The  clinic  must  be  supplemented  by 
a  social  service  bureau.  The  experienced  social  worker  must  join  with 
the  physician  in  dealing,  among  others,  with  the  following  cases : 

1.  Cases  which  do  not  seem  to  respond  to  the  treatment  given  in  the 
clinic  should  be  referred  to  the  social  service  bureau  for  investigation  in 
the  home,  to  determine,  if  possible,  what  conditions  of  the  home  surround- 
ings are  responsible.  If  additional  relief  is  needed,  such  as  food  or  cloth- 
ing, removal  to  a  home  for  convalescents,  or  change  of  occupation,  the 
necessary  steps  should  be  taken  to  furnish  the  needed  relief  directly,  or 
in  cooperation  with  the  charitable  agencies  of  the  City. 

2.  Patients  whose  condition,  from  a  preliminary  inquiry  at  the  ad- 
mission desk  or  in  the  clinic,  seem  to  require  a  more  searching  investiga- 
tion than  can  be  made  at  the  dispensary;  and  all  cases  of  a  certain  class, 
such  as  heart  cases,  neurasthenics,  etc.,  may  be  automatically  referred  to 
the  social  service  bureau. 

3.  Cases  in  which  it  is  especially  essential  that  the  patient  should  re- 
turn for  continued  treatment  should  be  referred  to  the  social  service  bu- 
reau for  investigation  if  they  fail  to  do  so.  If  the  failure  is  due  to  ignor- 
ance, negligence,  physical  inability,  or  other  cause,  the  necessary  steps 
should  be  taken  by  the  social  worker  to  secure  continued  treatment.  An 
efficient  follow-up  system  should  be  maintained  for  this  class  of  cases. 

4.  Patients  whose  condition  is  such  that  they  cannot  well  return  to 
the  clinic,  and  yet  is  not  serious  enough  to  necessitate  removal  to  a  hospital, 
should  be  referred  to  the  social  service  bureau  for  care  in  the  home.  If 
the  patient  is  improved  under  such  care  he  should  be  sent  to  the  clinic  for 
final  examination  by  the  doctor  before  being  discharged  as  cured.  If  not 
benefited  patients  should  either  return  to  the  clinic  or  be  removed  to  the 
hospital. 

5.  Convalescent  patients  who  are  discharged  from  the  hospital  to  give 
room  for  more  serious  cases  may  be  referred  to  the  out-patient  depart- 
ment for  occasional  treatment;  for  supervision  in  the  home  by  the  social 
service  worker;  or  possibly  for  removal  to  a  convalescent  home,  if  neces- 
sary. 

6.  Obstetrical  cases  under  the  observation  of  that  clinic  should  be  re- 
ferred to  the  social  service  bureau  for  nursing  during  and  after  parturi- 
tion. The  importance  of  trained  nursing  to  the  health  of  the  mother  and 
child  is  inestimable.  Through  the  instruction  of  the  obstetrician  in  the 
clinic  and  the  visiting  nurse  in  the  home  it  is  possible  to  overcome  the 
dangers  of  the  extensive  midwifery  practice.    The  following  from  the  Sec- 


484  HOSPITAL  COMMITTEE 

ond  Report  (1912)  of  the  Social  Service  Department  of  Lakeside  Hospital, 
Cleveland,  O.,  indicates  the  opportunities  in  this  direction: 

III.  The  number  of  confinements  attended  by  the  substitutes  for  midwifery 
was  larger  than  for  the  previous  year.  These  substitutes,  each  of  which  represent 
a  type,  are  as  follows : 

1.  Private  physicians,  who  for  nominal  or  no  fees,  delivered  433  women,  and 
the  district  nurses  of  the  Visiting  Nursing  Association  furnished  the  nursing  care. 

2.  The  Maternity  Dispensary  of  St.  Luke's  Hospital  delivered  and  cared  for 
205  cases  in  the  homes. 

3.  The  Obstetrical  Department  of  the  Dispensary  of  Lakeside  Hospital  and 
Western  Reserve  University  assisted  by  Senior  Students  delivered  540  cases  in  the 
homes,  and  Lakeside  Hospital  furnished  the  nursing  care  for  these  women  and 
babies. 

This  is  a  total  of  1,178  cases  delivered  in  the  homes,  a  goodly  number,  but  just 
one-eighth  of  what  it  soon  must  be,  if  we  eliminate  the  midwife,  and  at  that  without 
any  allowance  for  the  growth  of  the  City.  These  three  represent  all  the  types  of 
substitutes  ever  developed  to  displace  the  midwife  except  the  hospital,  but  maternity 
hospitals  are  not  in  themselves  an  economical  or  efficient  substitute  for  midwifery; 
they  are,  however,  essential  to  the  success  of  each  of  the  other  types  of  substitutes 
mentioned.  They  are  not  economical,  because  of  the  high  cost  of  construction  and 
equipment  of  hospitals  (at  least  $6,000.00  for  one  bed  and  crib)  and  of  the  mainte- 
nance cost  amounting  to  at  least  $4.00  per  day  for  mother  and  child.  They  are  not 
efficient  because  these  women  will  not  as  a  rule  voluntarily  go  to  a  hospital  unless 
convinced  that  it  is  absolutely  necessary,  and  an  aggressive  attempt  by  a  hospital  to 
secure  patients  would  be  misunderstood  and  therefore  futile. 

This  last  class  of  cases,  and  others  cited  above,  call  for  the  services  of 
a  visiting  nurse  rather  than  a  social  worker.  The  chief  function  of  the 
trained  visiting  nurse  is  to  render  such  nursing  service  as  may  be  required 
by  sick  people  viho  are  cared  for  in  their  homes  instead  of  in  a  hospital; 
she  is  only  incidentally  interested  in  the  social  causes  of  disease  and  the 
economic  condition  of  her  patient.  To  the  social  worker,  on  the  other  hand, 
the  successful  completion  of  the  medical  treatment  is  only  part  of  the  prob- 
lem. Her  chief  concern  is  to  make  a  social  diagnosis  of  disease,  to  judge 
of  the  family  and  social  causes  which  may  have  brought  about  the  break- 
down and  sickness  of  her  patient ;  in  order,  first,  to  aid  in  the  recovery  of 
the  patient;  and,  second,  by  finding  a  remedy  for  evil  conditions,  to  place 
the  patient  on  a  better  footing  than  before.  By  some  it  is  held  that  this 
function  of  the  social  worker  can  be  performed  by  a  trained  nurse  in  addi- 
tion to  her  nursing  service.  Others  hold  that  the  training  of  a  nurse  does 
not  fit  her  for  successful  social  work,  and  that  the  social  worker  should 
confine  herself  to  those  cases  that  require  both  social  and  medical  treat- 
ment, and  turn  over  those  cases  requiring  only  nursing  service  or  physical 
relief  to  nursing  associations  or  relief  agencies.  This  latter  view  is  strongly 
and  comprehensively  set  forth  by  Miss  Cannon  in  her  book  on  hospital 
social  work,  already  referred  to. 

In  actual  practice  the  functions  of  the  social  worker  and  the  visiting 
nurse  are  likely  to  overlap.  The  difference  of  opinion  as  to  their  proper 
sphere  must  be  left  for  future  determination.  The  best  methods  by  which 
the  social  worker  can  make  use  of  other  agencies  for  social  welfare  are  still 
in  process  of  being  worked  out.  It  may  be  observed,  however,  that  it 
would  not  seem  advisable  for  the  profession  of  social  work  to  enter  a 
field  already  occupied.  Rather,  in  fulfilling  her  own  distinctive  mission,  the 
social  worker  should  enlist  the  cooperation  of  relief  societies,  district  nurs- 
ing associations,  and  other  social  agencies  of  the  community. 


ORGANIZATION    AND    RECORDS    OF    THE    OUT-PATIENT 
DEPARTMENT 

An  efficiently  organized  and  adequate  staff  is  essential  if  the  best  re- 
sults are  to  be  secured.  Not  a  little  of  the  ineffective  treatment  at  Gouver- 
neur  Hospital  has  been  due  to  a  lack  of  organization,  as  well  as  to  a  lack 
of  facilities.  But  even  the  best  of  facilities  will  not  of  themselves  insure 
good  work.  There  must  be  an  administrative  head  of  the  out-patient  de- 
partment; an  adequate  medical  and  nursing  staff;  and  a  social  service  bu- 
reau or  department. 

General  Administration 

The  out-patient  department  should  be  in  charge  of  a  medical  officer 
who,  under  the  general  direction  of  the  superintendent  of  the  hospital, 
should  be  responsible  for  the  work  of  all  employees  in  the  dispensary,  and 
all  administrative  details,  except  the  work  of  the  medical  staff.  An  assis- 
tant superintendent  of  the  hospital  might  be  assigned  to  this  position,  which 
would  facilitate  the  closest  cooperation  between  the  hospital  and  the  out- 
patient service.  In  any  case  there  should  be  adequate  remuneration  and 
a  sufficient  tenure  of  office  to  insure  the  services  of  a  capable  and  experi- 
enced officer. 

The  method  of  admitting  patients  should  receive  the  most  careful  con- 
sideration. All  the  patients  entering  the  dispensary  must  come  to  the  ad- 
mission desk  for  a  preliminary  inquiry ;  either  to  be  sent  away,  if  not  deemed 
admissible  for  treatment,  or,  if  admitted,  to  be  assigned  to  the  proper 
clinics.  It  is,  therefore,  the  most  strategic  point  at  which  to  study  the  dis- 
pensary population  and  its  needs.  Varying  methods  of  admission  are 
used  in  different  institutions.  In  one  well-organized  out-patient  depart- 
ment this  function  is  performed  by  the  superintendent  himself,  who  is  a 
medical  officer,  and  who,  after  a  few  pointed  questions,  supplemented  occa- 
sionally by  a  brief  examination,  assigns  the  patients  to  their  respective 
clinics,  or  refuses  admission,  as  the  case  in  his  judgment  may  require.  In 
another  out-patient  department  this  work  is  entrusted  to  an  experienced 
social  worker.  Here  a  close  inquiry  is  made  into  the  social  condition  of  the 
patient,  to  learn,  if  possible,  whether  social  as  well  as  medical  treatment 
may  be  needed.  This  takes  more  time  and  often  requires  the  aid  of  two 
or  three  well  qualified  assistants.  One  of  these  is  a  man,  who  is  thought 
better  fitted  than  a  woman  to  interview  certain  adult  male  patients.  In  still 
another  out-patient  department  these  two  methods  are  in  part  united; 
that  is,  the  director  has  charge  of  the  admission  work,  assisted  by  several 
trained  social  workers.  The  purpose  here  is,  by  a  searching  inquiry  into 
the  patient's  social  condition  at  the  admission  desk,  to  avoid  most  of  the 
work  of  investigation  in  the  patient's  home,  otherwise  deemed  necessary. 
As  has  been  stated,  this  requires  much  time,  but  it  is  claimed  that  the  oppor- 
tunity afforded  to  study  the  patient,  and  the  information  secured,  are  worth 
all  it  costs.  The  varying  methods  have  not  been  sufficiently  worked  out  to 
make  it  safe  to  dogmatize  as  to  which  is  the  best,  though  there  is  a  ten- 
dency to  regard  the  admission  desk  as  the  logical  place  for  the  social 
worker.     Whatever  the  method  used  the  work  should  be  entrusted  to  a 

485 


486  HOSPITAL   COMMITTEE 

competent  official  and  not  left  to  a  subordinate  employee,  as  is  now  done 
at  Gouverneur  dispensary. 

The  foregoing  applies,  of  course,  only  to  the  new  patients  who  come  to 
the  out-patient  department  from  day  to  day,  and  who  must  be  separated 
from  the  old  patients  returning  after  the  first  visit  for  additional  treatment. 
In  investigating  the  work  of  Gouverneur  dispensary  it  was  found  that  there 
was  great  danger  from  the  presence  of  cases  of  contagious  diseases  in  the 
crowded  waiting  room.  Many  other  out-patient  departments  have  already 
provided  means  for  the  segregation  of  such  cases  immediately  after  en- 
trance. A  well  trained  officer,  either  a  physician  or  a  trained  nurse — pref- 
erably the  former — should  be  stationed  close  to  the  door,  for  the  purpose 
of  observing  more  or  less  closely,  the  incoming  people.  Those  showing 
suspicious  symptoms  of  scarlet  fever,  measles,  whooping-cough,  etc.,  should 
be  immediately  taken  to  the  detention  room  for  more  careful  examination 
and  a  proper  disposition  of  the  cases.  This  officer  could  at  the  same  time 
separate  the  old  patients  from  the  new  ones.  The  former  would  be  sent 
direct  to  the  registration  desk  to  pay  their  fee  and  secure  the  card  for  ad- 
mission to  the  clinic.  The  new  patients  would  first  have  to  go  to  the  ad- 
mitting officer  to  secure  admission  for  treatment,  and  would  then  pass  on 
to  the  registration  clerk  along  with  the  old  patients. 

The  Medical  Staff 

The  patient  comes  to  the  out-patient  department  to  be  cured  of  some 
illness,  more  or  less  severe.  All  things  else  must  minister  to  this  end.  At 
any  time  the  patient  is  admitted  he  should  be  given  the  best  help  the  dispen- 
sary has  to  give.  The  medical  service  must  be  maintained  at  a  uniformly 
high  level  every  day  in  the  week  and  every  week  in  the  year,  and  there 
must  be  the  closest  cooperation  in  the  treatment  of  cases,  between  the  sev- 
eral clinics,  and  between  these  and  the  hospital.  It  is  urged  by  good  author- 
ities that  the  best  way  to  secure  good  service  is  to  have  the  physicians  and 
surgeons  in  the  out-patient  department  occupy  corresponding  positions  on 
the  hospital  staff.  This  would  attract  the  best  men,  because  of  the  greater 
experience  and  prestige  derived  from  the  hospital  service.  The  plan  ap- 
pears ideal,  but  it  is  doubtful  whether  it  could  be  practically  applied  in  con- 
nection with  the  out-patient  departments  of  our  municipal  hospitals.  A 
modification  of  the  plan,  however,  may  be  adopted  by  having  the  chiefs  of 
divisions  of  the  out-patient  department  occupy  the  corresponding  positions 
in  the  hospital.  These  chiefs,  or  their  duly  qualified  assistants  or  deputy 
chiefs,  should  be  present  in  the  clinics  at  all  times,  and  have  a  close  super- 
vision of  the  medical  and  surgical  service.  Such  an  arrangement  would  fa- 
cilitate the  transfer  of  patients  from  the  out-patient  department  to  the  hos- 
pital, or  vice  versa,  and  insure  the  necessary  cooperation. 

Members  of  the  medical  staff  usually  give  their  services  free.  There 
are  some  exceptions,  as  at  Gouverneur,  where  a  small  payment  is  made. 
The  out-patient  department  is  supposed  to  offer  free  treatment  to  those 
who  cannot  afford  to  pay  for  the  services  of  a  private  practitioner,  and 
the  medical  man,  therefore,  is  expected  to  serve  without  payment,  his  only 
compensation,  aside  from  his  desire  to  aid  in  charity  work,  being  the  ex- 
perience gained  by  the  examination  and  treatment  of  a  large  number  of 
cases,  and  the  opportunity  offered  for  a  scientific  study  of  disease.  It  is 
questionable  whether  this  system  of  gratuitous  service  insures  good  results. 
The  best  service  is  likely  to  be  secured  if  the  clinic  is  utilized  for  teaching 


THE    OUT-PATIENT   DEPARTMENT  487 

purposes.  In  this  case  the  instructors  in  the  medical  school  would  have  posi- 
tions assigned  on  the  out-patient  staff,  and,  being  closely  obseived  by  the 
student,  would  give  careful  attention  to  correct  diagnosis  and  treatment. 
If  there  is  no  teaching  done,  however,  and  if  for  other  reasons  it  is  found 
difficult  to  obtain  good  men  for  the  out-patient  staff,  it  may  be  necessary  to 
pay  a  fair  remuneration  for  medical  service  in  order  to  secure  a  better 
quality  of  work  and  prompt  attendance  at  the  clinic.  The  chiefs  of  divi- 
sions who  are  required  to  give  most,  if  not  all,  of  their  time  to  the  work, 
must  be  paid  a  sum  sufficient  to  attract  capable  men  for  these  responsible 
positions. 

It  has  already  been  pointed  out  that  the  out-patient  department  should 
not  limit  its  service  to  the  very  poor.  People  of  moderate  means,  willing 
and  able  to  pay  something,  often  find  themselves  unable  to  secure  the 
needed  services  of  a  skilled  specialist.  To  meet  the  requirem.ents  of  these 
people  various  arrangements  have  been  made  in  several  out-patient  depart- 
ments. In  one  dispensary  a  charge  of  one  dollar  is  made  for  the  first  treat- 
ment in  the  eye  clinic,  and  fifty  cents  for  each  subsequent  visit.  Arrange- 
ment is  made  by  which  glasses  are  furnished  by  competent  opticians  at 
moderate  rates  to  those  who  can  pay,  and  free  to  those  who  cannot.  The 
director  of  another  out-patient  department  states  that,  "under  the  old  way 
of  sending  prescriptions  out  for  the  filling  there  is  so  much  graft  and  so 
much  poor  work,  in  addition  to  the  large  number  who  fail  to  get  any  glasses, 
that  I  believe  the  system  entirely  inadequate  and  out  of  date."  Unless  the 
optician's  part  of  the  work  is  well  done  the  services  rendered  by  eye  clinics 
will  be  largely  fruitless.  In  the  orthopedic,  physical  therapy,  and  other 
clinics  where  specialists'  services  are  required,  similar  arrangements  may 
be  made,  compensation  being  paid  by  the  out-patient  department  for  the 
services  of  such  specialists,  and  suitable  fees  collected  from  the  patients 
who  can  afford  to  pay. 

The  number  of  physicians  and  surgeons  in  each  clinic  depends  on  so 
many  factors  that  no  arbitrary  rule  of  any  value  can  be  laid  down.  The 
number  of  patients  attending  the  clinic  will  not  afford  a  sufficient  guide, 
owing  to  the  widely  varying  character  of  the  work  and  the  difference  in 
capacity  on  the  part  of  members  on  the  medical  staff.  Much  will  also  depend 
on  the  amount  and  character  of  assistance  given  to  the  physicians  and  sur- 
geons in  the  clinics  by  nurses  in  the  preparation  of  patients,  the  taking  of  tem- 
perature, etc. ;  and  by  the  social  service  worker  in  securing  social  informa- 
tion necessary  for  correct  diagnosis  and  treatment.  An  efficient  adminis- 
tration also  will  see  to  it  that  the  patients  are  brought  to  the  doctor  in 
rapid  succession,  so  as  to  avoid  a  waste  of  the  physician's  time,  and  that 
adequate  facilities  are  furnished  and  necessary  material  ready  to  his  hand. 
The  number  of  physicians  and  surgeons  needed  at  each  session  of  the  vari- 
ous clinics  can  probably  best  be  determined  by  the  chiefs  of  divisions,  from 
time  to  time.  There  should  be  a  large  enough  medical  staff  to  insure  care- 
ful diagnosis  and  adequate  treatment  to  all  patients  coming  to  the  clinics. 

In  this  connection  the  following  data,  obtained  from  Dr.  S.  S.  Gold- 
water,  Superintendent  of  Mt.  Sinai  Hospital,  will  be  of  interest.  The  out- 
patient department  of  this  Hospital  is  quite  large,  averaging  last  year  782 
patients  per  day  in  all  departments.  During  February,  1913,  the  number 
of  consultations  and  the  average  number  of  minutes  for  each  consultation 
in  the  separate  departments  were  as  follows : 


HOSPITAL   COMMITTEE 


Department 


Average  Number 
Total  Number  of        of  Minutes 
Consultations  for  each 

Consultation 


Children's 

Surgical 

Tuberculosis 

Medical 

Ear  and  Throat .  . 

Gynecology 

Genito-urinary .  .  . 

Neurology 

Eye 

Skin 

Orthopedic 

Radiotherapy .... 
Physical  Therapy. 


2,203 

9  • 

Vs 

3,277 

7  ' 

'h 

313 

11  i 

VlO 

3,210 

8  ■ 

V. 

1,489 

8  • 

Vs 

1,051 

12  ■ 

V.o 

527 

12  ' 

'h 

1,460 

5 

1,058 

7  ' 

7.0 

1,107 

8 

601 

9  1 

V.o 

313 

6  ' 

7.0 

598 

7  ' 

74 

In  the  several  divisions  within  the  same  clinic  there  was  found  to  be  a 
wide  variation  in  the  average  time  for  each  consultation.  In  one  division 
of  the  children's  clinic,  with  256  consultations,  the  average  time  was  4  3/5 
minutes;  in  another  division,  with  281  consultations,  the  average  was  15 
minutes.  In  the  surgical  clinic,  one  division,  with  322  consultations,  showed 
an  average  of  7  7/10  minutes,  and  another,  with  318  consultations,  an  aver- 
age of  12  1/2  minutes.  In  the  medical  clinic  the  average  time  in  one  divi- 
sion, with  237  consultations,  was  2  4/5  minutes ;  in  another  division,  with 
344  consultations,  it  was  14  minutes.  Similar  variations  occurred  in  other 
clinics.  As  this  dispensary  is  endeavoring  to  improve  the  quality  of  its  out- 
patient work  the  average  time  here  given  for  each  clinic  maj'  probabl)'  be 
considered  a  minimum,  but  in  view  of  the  wide  variations  noted  within 
the  same  clinics  it  should  be  taken  as  indicative  of  what  is  being  done, 
rather  than  as  a  standard  to  be  followed  in  other  out-patient  departments. 


The  Nursing  Staff 

More  and  more  consideration  is  being  given  to  the  work  of  the  nurse 
in  the  out-patient  department,  both  because  of  the  training  she  receives  and 
the  services  she  can  render  by  relieving  the  physician  or  surgeon  from 
certain  work  which  can  be  just  as  effectively  done  by  the  nurse,  such  as 
assisting  in  the  undressing  of  patients ;  in  bandaging  and  unbandaging ;  in 
the  preparation  of  materials ;  etc.  Owing  to  the  common  disregard  of  dis- 
pensary patients,  nurses  have  not  been  assigned  to  this  work,  and  yet  the 
members  of  the  out-patient  staff  treating  a  continual  stream  of  patients 
are  in  need  of  a  nurse's  assistance.  An  ample  nursing  staff  will  be  an 
added  incentive  in  attracting  good  men  to  the  out-patient  service,  because, 
being  relieved  of  unimportant  details  the  doctor  can  devote  his  entire  time 
and  interest  to  actual  medical  treatment.  It  is  also  desirable  that  the  nurses 
should  have  some  experience  in  the  out-patient  department  as  part  of  their 
training,  as  they  will  there  have  to  do  with  certain  classes  of  patients  and 
certain  kinds  of  work  not  found  in  the  hospital.  As  the  nurses  are  always 
under  the  direct  observation  of  a  physician  or  surgeon,  the  work  in  the  out- 
patient department  may  well  be  done  by  pupil  nurses  assigned  from  the 
training  school  of  the  hospital  during  the  last  year  or  six  months  of  the 
course,  and  under  the  general  oversight  of  a  trained  supervising  nurse. 


THE   OUT-PATIENT  DEPARTMENT  489 

The  number  of  nurses  assigned  to  the  various  cHnics  should  be  deter- 
mined by  the  amount  and  character  of  the  work  to  be  done,  rather  than  by 
the  number  of  physicians  and  surgeons.  There  should  be  enough  nurses 
to  relieve  the  physicians  and  surgeons  of  all  unnecessary  detail.  There 
should  probably  be  at  least  one  nurse  for  each  clinic;  in  certain  special 
clinics  and  in  those  virith  a  large  attendance  more  may  be  needed.  In  the 
children's  clinic,  in  the  general  surgical,  the  skin,  the  genito-urinary,  and 
others,  one  nurse  to  each  two  doctors  may  be  found  a  workable  ratio;  in 
other  clinics,  as  the  medical,  one  nurse  to  each  three  or  four  physicians  may 
be  sufficient.  The  actual  number  of  nurses  to  be  utilized  with  advantage  can 
be  decided  only  in  the  light  of  experience,  after  consultation  between  the 
chiefs  of  divisions  and  the  director  of  the  training  school  having  general 
charge  of  the  nurses'  training. 

Social  Service  Stafi 

The  function  of  the  social  service  bureau  has  been  dealt  with  at  some 
length.  Methods  of  organization  vary  widely  in  different  institutions. 
Sometimes  the  social  service  bureau  is  affiliated  with,  or  is  a  part  of,  the 
nurses'  training  school,  and  sometimes  it  is  under  a  volunteer  committee 
recognized  by  the  hospital  authorities.  The  former  plan  is  strongly  advo- 
cated by  some  good  authorities,  but  whether  it  is  advisable  or  not  will 
depend  on  how  much  visiting  nursing  is  to  be  done.  In  the  City's  out- 
patient departments  the  best  form  of  organization  will  probably  be  to  have 
the  social  service  bureau  independent  of  both  the  training  school  and  the 
medical  staff.  The  bureau  should  have  charge  of  all  social  service  work 
in  the  out-patient  department  and  in  the  hospital,  and  the  head  worker 
should  be  responsible  directly  to  the  superintendent  of  the  hospital. 

Plans  of  operation  are  still  in  the  process  of  being  worked  out.  Various 
methods  of  selecting  patients  for  investigation  by  the  social  worker  have 
been  suggested — the  admission  desk  has  been  spoken  of  as  a  strategic  point 
where  the  social  worker  has  especial  opportunity  to  study  the  social  condi- 
tions of  the  patients ;  the  physicians  and  surgeons  also  are  expected  to  refer 
patients  to  the  social  service  bureau  when  it  seems  to  be  required.  But  it 
is  felt  by  many  that  these  methods  are  inadequate;  many  patients  will 
escape  the  social  worker  at  the  admission  desk,  and  the  physician  is  often 
hurried  in  his  work  and  untrained  in  judging  of  social  conditions.  The 
plan  of  placing  the  social  worker  directly  in  the  several  clinics,  in  addition 
to  the  nurses,  has  been  adopted  in  the  Boston  Dispensary.  The  social 
worker  interviews  the  patient;  takes  the  social  history;  performs  the  func- 
tion of  a  social  diagnostician ;  and  confers  with  the  physician  as  to  proper 
methods  of  treatment  of  such  cases  as  may  require  it.  The  plan  is  said  to 
work  very  well ;  it  has  been  adopted  to  some  extent  in  the  Massachusetts 
General  and  other  out-patient  departments,  and  may  prove  to  be  the  ulti- 
mate plan  to  be  followed. 

This  plan  will,  of  course,  require  a  larger  number  of  social  service 
workers,  but  it  promises  also  more  work  done  and  better  results.  It  should 
be  tried.  At  least  four  or  five  trained  social  workers  should  be  assigned  to 
appropriate  clinics  in  the  Gouverneur  Out-Patient  Department,  such  as  the 
children's,  and  there  should  be,  in  addition,  several  others  on  the  staff 
of  the  bureau  for  general  assignment.  This  number  may  then  be  increased 
as  experience  seems  to  justify  it.  If  it  is  found  necessary  to  do  the  work 
of  visiting  nurses  some  of  those  on  the  staff  must  be  trained  nurses.    It  is 


490  HOSPITAL   COMMITTEE 

thought  to  be  inadvisable  to  have  the  visiting  nursing  done  by  pupil 
nurses,  as  they  have  not  the  necessary  quaHfications  and  training,  especially 
in  judging  of  social  conditions.  Only  for  the  purpose  of  experience  and 
training  should  senior  pupil  nurses  be  permitted  to  do  this  work,  and  then 
only  under  strict  supervision  of  experienced  workers.  The  social  service 
bureau  should  not  assume  too  many  functions.  It  should  avoid  duplicating 
the  effort  of  other  agencies,  and  confine  itself  chiefly  to  the  function  of 
social  investigation  and  social  diagnosis.  For  this  special  work  the  trained 
social  worker  will  be  needed. 

Medical  and  Social  Records 

The  records  in  many  out-patient  departments  are  kept  in  a  more  or  less 
haphazard  manner,  and  often  there  are  no  records  of  any  kind ;  yet,  a  good 
record  system  is  essential  for  efficiency,  both  in  the  general  administration 
and  in  the  medical  service.  It  is  probably  not  too  much  to  say  that  the 
quality  of  the  medical  service  is  indicated  quite  accurately  by  the  character 
of  the  records  kept.  The  physician  often  finds  it  necessary  to  inquire  into 
the  patient's  family  history  and  his  past  habits,  and  may,  in  addition,  re- 
quire information  about  his  social  condition,  before  an  accurate  diagnosis 
can  be  made  and  successful  treatment  prescribed.  The  systematic  record- 
ing of  both  social  and  medical  facts  regarding  a  patient  is  of  greatest  im- 
portance, not  only  for  the  correct  diagnosis  of  present  ills,  but  for  future 
reference,  for  teaching  purposes,  and  for  social  investigations. 

In  the  study  of  a  considerable  number  of  cases  made  at  the  Boston  Dis- 
pensary it  was  estimated  that  from  25  per  cent,  to  30  per  cent,  of  all  cases 
treated  at  that  institution  were  in  need  of  both  social  and  medical  treatment. 
In  this  many  cases,  at  least,  the  social  information  concerning  the  patient  is 
indispensable  to  the  physician  if  the  treatment  prescribed  is  to  be  success- 
ful. In  many  out-patient  departments  the  medical  records  are  kept  in  one 
place  and  the  social  records  in  another,  and  an  attempt  is  made  to  make  the 
information  on  the  social  records  available  to  the  physician  by  placing  on 
the  patient's  medical  record  a  reference  to  the  social  service  file.  Although 
the  information  of  a  patient's  social  condition  is  largely  of  an  intimate  and 
confidential  nature,  more  and  more  consideration  is  being  given  to  some 
plan  of  filing  both  social  and  medical  histories  together.  In  the  Lakeside 
Dispensary,  Cleveland,  the  medical  histories  are  filed  in  an  envelope  on 
which  is  noted  the  name,  the  civic  condition,  nationality  of  the  patient,  and 
other  social  facts.  In  Boston  Dispensary  similar  facts  are  placed  at  the 
head  of  the  patient's  medical  record.  Such  a  form  of  card  is  found  in  the 
appendix.  The  social  information  here  indicated  should  probably  be  taken 
of  all  patients  admitted  for  treatment,  either  at  the  admission  desk  or  in 
certain  clinics,  as  might  be  found  to  be  the  more  convenient.  A  more  de- 
tailed social  record  could  be  taken  of  those  patients  referred  for  investiga- 
tion to  the  social  service  department. 

The  forms  of  records  used  vary  widely  in  different  institutions.  No 
standard  has  as  yet  been  adopted,  and  practically  the  records  of  no  two  in- 
stitutions are  quite  alike.  It  would  seem  unnecessary  that  each  out-patient 
department  should  have  a  system  of  records  different  from  all  others,  but 
the  point  has  hardly  yet  been  reached  where  a  form  for  general  use  can 
be  proposed.  A  suggested  form  for  the  general  medical  and  gynecological 
clinics  will  be  found  in  the  appendix.  Similar  forms  for  other  clinics  will 
vary  with  the  requirements  of  those  clinics.     It  will  be  noticed  that  a  con- 


THE   OUT-PATIENT  DEPARTMENT  49I 

siderable  number  of  items  are  printed  on  these  records,  so  that  the  physician 
need  only  check  off  or  write  in  its  appropriate  place  the  necessary  data.  It 
saves  the  physician's  time,  and  is  said  to  be  used  in  some  out-patient  de- 
partments with  satisfactory  results;  but  this  form  is  sharply  criticized  by 
other  good  authorities,  who  claim  that  it  does  not  insure  a  good  record, 
and  is  worthless  if  items  are  incorrectly  entered.  It  is  thought  that  a  better 
history  will  be  secured  by  a  form  with  comparatively  few  headings,  re- 
quiring the  physician  to  write  out  the  essential  facts.  The  value  of  the 
record  undoubtedly  depends  more  upon  the  care  with  which  it  is  written 
than  upon  the  number  of  facts  secured  or  the  length  of  the  record.  The 
interest  of  the  medical  staff,  and  especially  of  the  chiefs  of  the  clinic,  should 
be  secured  by  consultation  as  to  the  best  form  of  record  suited  to  local  re- 
quirements. 

As  the  systems  of  records  differ,  so  also  do  the  methods  of  filing.  In 
some  out-patient  departments  the  records  are  filed  in  the  different  clinics, 
while  in  others  the  records  of  the  smaller  cHnics  are  filed  in  one  central 
record  room;  those  of  the  larger  clinics,  as  the  general  medical,  being  filed 
separately  in  those  clinics.  In  several  well-organized  dispensaries  the  sys- 
tem of  filing  is  completely  centralized;  that  is,  all  records  are  kept  in  one 
room,  placed  in  charge  of  a  filing  clerk.  From  these  files  the  histories  are 
taken  and  sent  to  the  clinics  when  the  patients  apply  for  treatment.  Some 
dispensaries  entrust  the  records  to  the  patients  themselves,  and  claim  that 
no  serious  loss  of  records  or  other  inconvenience  results  therefrom,  but  in 
other  dispensaries,  using  the  centralized  system,  it  is  held  that  under  no 
circumstances  should  the  patient  be  in  possession  of  his  own  medical  and 
social  history,  which  should  be  sent  directly  to  the  clinic  by  pages  employed 
for  the  purpose,  or  by  other  means.  The  patient's  history  is  filed  by  num- 
ber, and  a  name  index  to  the  records  is  made  on  a  small  card.  A  diagnosis 
index  on  a  similar  card  is  also  made  in  some  institutions,  so  as  to  bring  to- 
gether all  cases  of  the  same  class.  This  is  of  special  importance  to  the  phy- 
sician, and  quite  indispensable  for  teaching  purposes. 

Blank  forms  should  be  provided  to  facilitate  the  work  of  the  out-patient 
department,  and  the  cooperation  of  the  various  clinics  with  each  other  and 
with  the  hospital.  Various  forms  for  these  purposes  will  be  found  in  the 
appendix. 

Standard  Formulae  for  the  Pharmacy 

In  an  out-patient  department  where  there  will  be  so  many  cases  of  like 
character  treated,  and  vi^here  there  will  necessarily  be  so  many  similar  pre- 
scriptions, a  great  saving  in  time  is  eft'ected  by  having  certain  standard  for- 
mulae for  prescriptions,  each  of  which  vvould  be  known  by  some  character- 
istic title.  These  standard  formulae  should  be  printed  in  booklet  form  and 
given  to  each  pliysician  and  surgeon  and  to  the  drug  room  assistants. 
Apothecaries  working  at  periods  when  patients  are  not  in  attendance,  or 
when  the  attendance  is  light,  would  prepare  large  quantities  of  these 
standard  prescriptions  and  have  them,  ready  to  dispense  to  patients  during 
the  busy  hours.  The  advantage  of  this  sort  of  preparation  is,  of  course, 
obvious.  In  Mount  Sinai  Dispensary,  New  York  City,  it  was  found,  on 
actual  count,  that  by  the  use  of  a  formulary  which  had  been  elaborately 
worked  out  in  that  institution  it  was  possible  to  dispense  100  medications 
in  five  minutes.  In  out-patient  departments  where  such  preparation  has 
not  been  made  there  is  a  great  deal  of  time  spent  at  the  drug  room  window, 
waiting  for  prescriptions  to  be  filled,  with  a  resulting  congestion  at  that 
particular  point. 


THE    PHYSICAL    PLANT 

Location  and  Site 

If  the  out-patient  department  is  operated  in  connection  with  the  hospi- 
tal it  is,  of  course,  more  economical,  both  as  to  construction  and  operation, 
to  locate  it  in  close  proximity  to  the  hospital.  One  heating  plant  and  one 
drug  room  would  suffice  for  both  institutions,  and  the  hospital  laundry 
would  be  available  for  necessary  work.  Certain  expensive  equipment  need 
not  be  duplicated,  if  already  provided  in  the  hospital,  such  as  X-ray  and 
hydro-therapeutic  apparatus,  and  the  accident  ward  of  the  hospital  might  be 
advantageously  merged  with  the  out-patient  department,  as  has  been  done 
in  several  instances,  and  patients  could  be  more  easily  transferred  from 
the  out-patient  department  to  the  hospital  or  from  the  hospital  to  the  out- 
patient department,  as  might  be  required. 

In  choosing  a  site  for  an  out-patient  department  first  consideration 
should  be  given  to  light  and  ventilation.  Good  light  is  especially  desirable 
in  the  surgical  rooms  and  in  those  used  for  skin  examinations.  Good  nat- 
ural ventilation  should  be  secured  wherever  possible,  although  this  may 
have  to  be  supplemented  by  a  system  of  artificial  ventilation,  particularly 
where  the  attendance  is  very  heavy.  The  most  desirable  site,  of  course, 
would  be  one  removed  from  the  noise  and  dust  associated  with  heavy  traf- 
fic and  large  factories,  as  these  conditions  seriously  interfere  with  the  work 
in  many  departments. 

Size  and  Type  of  Building 

The  area  of  the  site  available  for  an  out-patient  department  will  often 
determine  the  type  of  building  to  be  erected ;  especially  in  New  York, 
where  the  area  is  usually  very  much  restricted,  and  the  rectangular  type  of 
building  of  two  or  more  stories,  therefore,  most  common.  Where  an  ex- 
pansive site  is  available,  however,  it  may  be  well  to  consider  the  relative 
advantages  of  several  types  of  buildings.  Whatever  flie  type  of  building  to 
be  erected  the  size  will  be  determined  by  the  average  and  maximum  num- 
ber of  patients,  both  new  and  return  cases,  treated  daily  in  each  clinic; 
by  the  number  and  character  of  the  clinics  maintained  and  the  facilities 
placed  at  their  disposal;  by  the  number  of  daily  sessions  held  by  each  of 
these  clinics ;  by  the  number  of  students  and  attendants  and  the  amount  of 
teaching  done,  if  any;  and  by  the  waiting  room  and  other  provisions  to 
be  made  for  the  convenience  and  comfort  of  both  physicians  and  patients. 

I.  The  one-story  building  has  certain  obvious  advantages  in  making 
stairways  and  elevators  unnecessary.  It  assures  good  light  and  good  ven- 
tilation. It  is  comparatively  easy  to  keep  the  incoming  and  departing  pa- 
tients separate,  and  to  direct  the  patients  to  their  separate  clinics.  Yet 
these  and  other  advantages  of  a  one-story  building  are  apparently  more 
than  offset  by  the  undoubtedly  greater  cost  of  construction  and  operation 
of  such  a  building;  much  more  space  is  needed  for  corridors;  the  cost  of 
foundation  and  roofing  is  proportionately  high ;  and  more  attendants  re- 
quired on  account  of  the  large  area  covered. 

492 


THE   OUT-PATIENT  DEPARTMENT  493 

2.  The  L-shaped  building,  whether  one  or  more  stories,  is  a  modifica- 
tion of  the  rectangular  type.  It  affords  an  opportunity  to  place  a  large 
waiting  room  on  each  floor  at  the  junction  of  the  two  wings.  Corridors 
lead  off  from  these  waiting  rooms  to  the  examination  rooms  located  in  the 
two  wings,  and  at  the  farther  end  of  these,  drug  rooms  are  conveniently 
located  near  the  exits  for  the  patients.  The  confusion  and  commingling 
of  different  classes  of  patients  is  thus  largely  avoided  by  an  orderly  prcn 
cedure  of  incoming  patients  to  the  admission  desk,  the  waiting  room,  the 
treatment  room,  and  the  drug  room  near  the  exit ;  and  good  light  and  ven- 
tilation can  be  secured,  especially  in  the  waiting  room.  On  the  other  hand, 
as  in  the  case  of  the  one-story  building,  a  proportionately  large  floor  area 
is  needed  for  corridors,  and  some  of  the  treatment  rooms  are  too  far  away 
from  the  waiting  rooms,  requiring,  with  the  exits,  more  attendants  than 
are  needed  in  a  more  compact  arrangement.  The  two  exits  also  require 
two  drug  rooms,  at  some  distance  from  each  other,  which  means  an  addi- 
tional expense  for  attendants.  When  three  or  more  stories  high  an  eleva- 
tor would  be  required,  as  in  the  next  type  of  building. 

3.  Another  type  is  the  multi-story  building,  which  may  be  rectangular 
or  square.  It  is  much  more  compact  than  a  one-story  building  having  the 
same  total  floor  space,  and  the  cost  of  construction,  heating,  and  plumbing 
is  therefore  less  than  in  the  former  type.  It  is  also  more  economical  in  gen- 
eral operation,  since  a  very  large  number  of  patients  can  be  supervised  and 
directed  by  a  minimum  number  of  attendants.  It  is  necessary  to  have  an 
elevator,  but  this  need  not  be  a  serious  objection  if  those  departments 
having  the  largest  attendance  are  located  on  the  first  and  second  floors ; 
and  a  careful  distribution  of  the  clinics  on  the  several  floors  will  tend  to 
prevent  the  confusion  of  one  class  of  patients  with  another.  If  the  site  is 
large  there  will  be  an  abundance  of  light  and  ventilation,  but  if  it  is  re- 
stricted by  adjoining  buildings,  careful  planning  will  be  necessary  to  secure 
the  greatest  amount  of  natural  light  and  ventilation.  On  the  whole,  this 
type  of  building  is  probably  to  be  preferred,  even  where  a  large  site  will 
permit  another  style  of  construction. 

Details  of  Architecture  and  Construction 

The  technical  details  of  architecture  and  construction  should  be  left 
largely  in  the  hands  of  competent  architects  experienced  in  this  Hne  of 
work.    Only  a  few  observations  of  a  general  nature  will  be  made  here. 

The  style  of  architecture  should  be  strictly  subordinated  to  the  practical 
use  of  the  building.  As  large  numbers  of  people  come  daily  for  treat- 
ment the  first  requisites  are  safety,  sanitation,  ventilation,  and  light,  and 
the  ornamental  features  of  the  building  should  not  be  permitted  to  inter- 
fere with  these.  The  construction  should  be  fireproof,  and  of  such  mate- 
rial that  cleanliness  can  be  maintained  continually  at  a  minimum  expense. 
Interior  ornaments  and  horizontal  surfaces  generally  should  be  avoided. 
A  good  architectural  composition  along  reasonably  straight  lines  is  the  best 
and  most  economical,  both  in  construction  and  operation. 

Heating  and  Ventilation 

Natural  ventilation  is  the  best.  The  out-patient  building  should  be  lo- 
cated and  constructed  so  as  to  permit  the  greatest  amount  of  air  circu- 
lation around  and  through  the  building.  Transoms  over  the  doors  and  win- 
dows should  be  provided,  ventilators  may  be  attached  to  the  bottom  of  the 


494  HOSPITAL    COMMITTEE 

sash,  or  other  fresh  air  inlets  provided.  For  a  large  part  of  the  j'ear  this 
may  be  sufficient.  At  other  times,  as  in  hot,  humid  days  in  summer,  or 
when  the  windows  must  be  closed  on  account  of  dust  or  noises,  or  in  cold 
weather,  it  may  be  necessary  to  aid  natural  ventilation  by  a  system  of  arti- 
ficial ventilation.  This  should  be  of  the  simplest  description.  Exhaust 
fans,  properly  located  with  reference  to  such  rooms  as  the  waiting  room, 
operating  room,  toilet  rooms,  and  others,  will  serve  the  purpose.  In  heat- 
ing, a  system  of  direct  radiation  is  to  be  preferred,  and  it  should  be  en- 
tirely independent  of  ventilation. 

Light  and  Illumination 

The  windows  should  be  sufficient  in  size  and  number  to  provide  an 
abundance  of  natural  light,  and  should  not  be  subordinated  to  architectural 
appearance.  A  glaring  artificial  light,  fatiguing  to  the  eye,  should  be 
avoided,  as  should  also  all  forms  of  expensive  indirect  illumination.  As 
illumination  is  affected  to  a  large  degree  by  the  color  and  finish  of  walls 
and  ceilings,  these  should  receive  due  consideration.  All  fixtures  should 
be  of  the  simplest  type,  with  no  ornamentation  or  unnecessary  angles. 

Plumbing  and  Fixtures 

All  plumbing  v\"ork  should  be  exposed  and  kept  free  of  the  wall  or 
floor  wherever  possible,  so  as  to  facilitate  detection  of  leaks  and  to  render 
cleaning  easy.  Basins,  sinks,  and  other  fixtures  should  be  liberally  sup- 
plied in  all  rooms  where  needed,  and  should  be  of  the  simplest  pattern. 
Enameled  iron  can  be  substituted  for  porcelain.  Nickel  plated  or  polished 
brass  is  expensive  and  may  be  avoided.  All  waste  pipes,  traps,  etc.,  may 
be  painted  instead  of  polished. 

Floors 

The  floors  of  an  out-patient  department,  as  in  other  parts  of  a  hospi- 
tal, should  be  sanitary,  non-absorbent,  and  easily  cleaned.  Unlike  the 
floors  of  a  hospital  ward,  where  a  trained  nurse  is  always  on  duty,  the  dis- 
pensary floor  need  not  be  resilient ;  wood  and  linoleum  are  therefore  less 
needed,  and  composition  floors  have  not  yet  proven  entirely  satisfactory. 
Cement  makes  the  cheapest  fireproof  floor,  but  is  rough,  absorbent,  and 
unsightly.  For  certain  rooms  terrazzo,  or  tiling,  or  a  combination  of  the 
two,  will  best  answer  the  requirements  of  an  out-patient  department. 

Walls  and  Partitions 

For  the  finish  of  interior  walls  and  partitions  hard  plaster  is  service- 
able in  most  places ;  white  tile  is  better,  and,  though  more  expensive,  may 
have  to  be  used  in  certain  rooms  to  a  height  of  four  feet  or  more.  A  light- 
gray  or  buff  color  on  the  walls  will  promote  illumination.  The  partitions, 
wherever  possible,  should  be  of  a  light  construction,  so  that  they  may  be 
easily  moved  in  case  it  is  found  necessary  to  alter  rooms  to  meet  chang- 
ing needs  and  new  conditions. 

Further  Considerations  in  Planning 

The  floor  space  in  an  out-patient  department  is  of  fundamental  impor- 
tance. Efficiency  in  administration  and  the  quality  of  work  done  are 
largely  aiTected  by  the  arrangement  of  rooms  and  spaces.    Only  such  fea- 


THE   OUT-PATIENT  DEPARTMENT 


495 


tures  as  directly  affect  the  handling  and  treatment  of  patients  will  be  here 
considered. 

Entrances  and  Exits 

The  number  and  location  of  entrances  and  exits  are  important  factors 
in  the  problem  of  handling  large  numbers  of  dispensary  patients.  Separate 
entrances  for  men,  women,  and  children,  or  for  different  classes  of  patients, 
except  as  hereinafter  noted,  are  thought  to  be  both  unnecessary  and  unde- 
sirable, as  they  are  likely  to  lead  to  confusion  or  to  cause  an  undue  expense 
in  maintaining  proper  supervision  over  large  numbers  of  people  unfa- 
mihar  with  the  arrangements.  One  entrance  for  all  patients — except  tu- 
berculous and  return  cases  of  infectious  diseases,  if  they  are  to  be  treated 
in  the  out-patient  department — would  be  satisfactory.  It  is  essential  to 
administrative  efficiency  to  provide  another  door  for  exit,  so  as  to  keep 
separate  the  incoming  and  outgoing  patients.  These  doors  should  be  close 
together,  however,  so  that  one  attendant  may  be  able  to  supervise  all  the 
patients  entering  and  leaving  the  building.  In  the  L-shaped  plan  of  build- 
ing an  exit  at  the  end  of  either  wing,  separate  from  the  entrance,  will  nat- 
urally be  provided,  permitting  the  patients  to  be  kept  moving  in  one  direc- 
tion, without  confusion  and  cross  currents.  But  such  an  arrangement 
means  more  attendants,  and,  therefore,  greater  cost  for  supervision. 

The  tuberculosis  clinic  should  be  separated  from  the  other  clinics  of  the 
out-patient  department,  preferably  with  its  own  entrance  door  exclusively 
for  this  class  of  patients.  If  whooping-cough  or  other  contagious  diseases 
are  admitted,  they  should  likewise  be  isolated  from  other  patients  and  pro- 
vided with  a  separate  entrance,  and  it  is  advisable  that  there  should  be  still 
another  entrance  for  the  physicians,  nurses,  and  attendants. 

Waiting  Rooms  and  Admissions 

The  entrance  hall  and  waiting  room  require  careful  attention  to  avoid 
crowded  conditions  and  confusion  generally,  especially  where  large  num- 
bers of  those  unfamiliar  with  the  surroundings  are  received.  It  is  obvious 
that  patients  should  be  seated  close  to,  or  in,  their  respective  clinics,  so 
that  they  may  be  readily  called  for  examination  and  treatment,  and  be 
easily  supervised  by  few  attendants.  Two  plans  may  be  considered :  to 
provide  a  large  waiting  room  on  the  first  floor  and  a  somewhat  smaller 
space  on  each  floor  above,  in  a  multi-story  building,  in  which  all  patients 
are  seated ;  or  smaller  waiting  rooms  in  connection  with  the  separate  clin- 
ics. By  the  latter  plan  the  patients  are  seated  near  the  clinic  in  which  they 
are  to  be  treated,  which  facilitates  rapid  operation,  but  these  special  wait- 
ing rooms  will  occupy  valuable  space  which  could  be  used  to  advantage 
for  other  clinics,  and  they  require  too  many  attendants  for  supervision.  A 
central  waiting  room  is  more  compact  and  more  easily  supervised,  and 
there  is  no  special  reason  for  separate  waiting  rooms  for  the  sexes  so  long 
as  separate  examination  rooms  are  provided.  In  the  L-type  of  building, 
such  a  waiting  room  will  naturally  be  provided  at  the  junction  of  the  two 
wings,  but  it  will  be  distant  from  most  of  the  clinics  and,  therefore, 
more  attendants  will  be  needed  to  bring  patients  to  the  treatment  rooms  at 
the  proper  time.  In  a  rectangular  building  the  clinics  can  be  located  on 
two  or  more  sides  of  a  central  waiting  room,  and  sections  of  this  waiting 
room  may  be  set  off  for  different  clinics  by  colored  signs  or  lights,  which 
would  correspond  to  the  color  of  the  admission  cards  given  to  the  patients. 


496  HOSPITAL   COMMITTEE 

This  is  of  special  importance  in  those  clinics  with  a  large  attendance,  such 
as  the  medical,  surgical,  and  children's  clinics,  for  where  these  are  located 
on  different  floors,  the  waiting  room  on  such  floor  becomes  largely  a  spe- 
cial waiting  room  for  these  clinics.  In  this  plan  easy  supervision  is  com- 
bined with  proximity  of  patients  to  the  clinics  in  which  they  are  to  be 
treated. 

Special  attention  must  be  given  to  those  patients  who  come  an  hour  or 
two  before  the  physicians  begin  treatment.  As  they  will  not  go  away,  and 
cannot  be  left  standing  outside,  they  must  be  admitted  to  the  building. 
They  may  then  be  handled  in  one  of  two  ways.  They  may  be  examined 
by  the  admitting  officials  and  registered  at  once,  and  then  sent  to  the  regu- 
lar waiting  rooms  to  await  the  opening  of  the  clinic.  This  would  avoid  the 
need  for  special  waiting  rooms  and  give  more  time  to  careful  examination 
of  the  new  patients,  but  it  would  also  require  the  officials  to  go  on  duty  long 
in  advance  of  the  regular  hours.  A  second  plan  is  to  provide  space  in  the 
main  entrance  hall,  where  these  patients  can  wait  until  the  hour  of  opening 
or  until  such  time  as  the  admitting  officials  begin  the  work  of  admission. 
The  number  of  patients  coming  too  early  will  vary  in  different  localities, 
but  can  be  regulated  to  a  greater  or  less  extent  by  continued  admonition 
against  the  practice  of  early  coming.  This  special  waiting  space  will  also 
be  very  serviceable,  if  not  indispensable,  in  caring  for  an  unusual  crowd. 
The  attendance  at  out-patient  departments  is  often  very  irregular  and  at 
times  the  patients  come  in  such  large  numbers  that  the  admitting  officials 
cannot  examine  them  as  they  come  and  some  provision  must  be  made  for 
the  excess  number.  This  special  waiting  space,  if  economy  compels,  may 
be  part  of  the  regular  waiting  space,  if  it  be  so  arranged  that  the  early 
comers  may  readily  reach  the  admitting  desk  when  the  regular  time  for 
admission  arrives. 

Number,  Arrangement,  and  T3rpe  of  Seats 

The  number  of  seats  needed  will  depend  very  much  on  the  method 
of  operation,  which  will  be  discussed  on  succeeding  pages.  The  seating 
capacity  is  woefully  inadequate  in  many  out-patient  departments,  and  a 
liberal  provision  for  seats  should  be  made.  Where  efficient  work  is  done 
it  is  obvious  that  a  large  percentage  of  the  patients  treated  in  one-half  day 
will  be  there  at  one  time — it  was  found  by  actual  count,  in  one  such 
out-patient  department,  that  the  number  of  people  seated  at  one  time  was 
from  85  to  90  per  cent,  of  the  number  treated  in  that  dispensary  during 
the  half  day  on  which  the  count  was  made.  Moreover,  many  patients  are 
accompanied  by  friends  or  relatives :  children  are  usually  accompanied  by 
their  parents,  who  bring  other  children  with  them.  Seats  must  be  provided, 
therefore,  for  many  people  who  are  not  patients.  In  children's  clinics  a 
fair  estimate  is  two  seats  for  each  child  in  attendance  as  a  patient.  For 
the  other  clinics  seats  should  be  provided  equal  to  the  maximum  number 
of  patients  treated  in  each  clinic  during  each  half  day  session. 

Seats  for  the  patients  for  each  clinic  should  be  arranged  in  a  group 
near  the  clinic,  and  these  groups  should  be  separated  from  each  other  by 
a  colored  sign,  which  could  be  moved  as  the  attendance  varies  in  the  differ- 
ent clinics.  This  arrangement  requires  no  more  seats  than  would  other- 
wise be  needed,  and  it  will  help  to  prevent  confusion.  By  such  an  ar- 
rangement patients  can  more  easily  find  their  proper  place,  and  fewer 
attendants  will  be  required.    Once  seated,  patients  should  not  be  required 


THE   OUT-PATIENT   DEPARTMENT  497 

to  move  until  called  to  the  examination  room.  If  a  single  entrance  to  a 
group  of  seats  is  provided,  and  a  single  exit  on  the  other  side  of  that 
group  nearest  the  examination  room,  the  result  will  be  that  a  large  num- 
ber of  seats  will  not  be  occupied.  The  arrangement  should  be  such  that 
the  vacant  seats  will  be  readily  occupied  by  the  patients  as  they  come,  and, 
to  insure  that  the  patients  are  treated  in  the  proper  order,  they  should  be 
given  a  consecutive  number  by  the  registration  clerk,  which  will  be  called 
for  by  the  examining  physician. 

The  seats  provided  should  be  of  a  substantial  character,  and  not  easily 
moved  by  the  patients.  They  should  not  be  fixed,  as  it  will  be  necessary 
to  move  or  tilt  them  in  order  to  facilitate  the  washing  and  cleaning  of  the 
floor.  A  good  type  is  a  low  bench,  with  solid  seat,  and,  perhaps,  solid 
back.  These  should  be  of  a  standard  size,  each  possibly  seating  six  per- 
sons, so  that  they  could  be  available  for  different  combinations  and  group- 
ings if  it  should  be  desired  to  change  the  number  of  seats  for  any  group  of 
patients. 

Sessions  of  the  Clinics 

It  is  obvious  that  the  number  of  patients  to  be  accommodated  at  one 
time  in  the  various  clinics  will  depend  in  a  large  measure  upon  the  method 
of  operating  the  out-patient  department.  Before  plans  are  prepared  these 
questions  must  be  considered :  ( i )  Should  rooms  be  provided  for  the  ex- 
clusive use  of  each  clinic,  or  should  some  or  all  of  them  be  used  for  one 
class  of  patients  in  the  forenoon  and  another  class  of  patients  in  the  after- 
noon? (2)  Should  there  be  one,  two,  or  three  sessions  a  day  for  the  treat- 
ment of  some  or  all  classes  of  cases? 

In  regard  to  using  the  same  rooms  for  the  treatment  of  different  classes 
of  cases  at  different  times  of  the  day,  it  may  be  said  that  it  requires  greater 
watchfulness  to  guard  against  infection  when  rooms  for  the  treatment  of 
skin  diseases,  genito-urinary  cases,  certain  septic  surgical  cases,  and  tuber- 
culosis are  used  the  same  day  for  the  treatment  of  other  patients,  especially 
children.  The  opinion  of  physicians  differ  on  this  point,  but  the  weight  of 
authority  seems  to  be  against  this  practice.  Also,  the  rooms  designed  for 
one  class  of  patients  are  often  not  well  adapted  for  the  treatment  of  an- 
other class.  In  an  out-patient  department  where  several  hundred  patients 
are  in  attendance  each  day  it  is  undoubtedly  better  to  have  rooms  provided 
for  the  exclusive  use  of  each  clinic. 

Assuming,  therefore,  that  each  clinic  is  to  have  its  own  rooms,  there 
are  still  several  plans  of  operation  which  affect  the  size  and  arrangement 
of  treatment  rooms.  One  plan  is  to  have  the  building  open  only  once  a 
day  and  all  classes  of  cases  received.  This  would  require  a  large  building, 
which  must  stand  unused  most  of  the  time.  Another  plan  is  to  admit  cer- 
tain classes  of  cases  in  the  forenoon  and  other  classes  in  the  afternoon, 
which  would  diminish  the  number  of  patients  to  be  handled  at  one  time 
and  therefore  require  a  smaller  building.  A  third  plan  is  to  keep  the  build- 
ing open  both  forenoon  and  afternoon  for  all  patients,  or  at  least  for  those 
classes  of  patients  in  which  the  attendance  is  large  enough  to  warrant  it. 
This  plan  seems  preferable,  for,  as  in  the  second  plan,  it  requires  a  build- 
ing only  of  moderate  size  and  is  continually  in  use.  It  is  convenient  for 
patients,  as  it  affords  them  a  choice  of  time ;  it  also  tends  to  secure  a  better 
class  of  physicians,  since  they  are  given  a  choice  of  forenoon  or  after- 
noon. 


498  HOSPITAL   COMMITTEE 

This  plan  may  be  modified  by  opening  certain  clinics  in  the  evening 
also,  for  many  men  and  women  cannot  leave  their  occupations  to  attend  a 
clinic  during  the  day.  In  one  out-patient  department  the  male  attendance 
for  a  short  period  in  certain  clinics  was  increased  53  per  cent,  because  the 
men  in  that  district  were  out  of  work  on  account  of  a  strike  and  thus  had 
time  to  attend  the  clinic.  In  order  to  accommodate  these  patients  an  even- 
ing session  is  very  desirable,  especially  for  such  clinics  as  the  general  medi- 
cal and  surgical,  the  gynecological,  and  the  genito-urinary.  The  third  ses- 
sion would  not  influence  the  size  or  plan  of  the  building,  and  could  be  in- 
troduced when  conditions  justified  it,  or  when  the  attendance  at  certain 
clinics  became  so  large  as  to  make  it  necessary. 

Arrangement  of  Clinics 

The  number  and  character  of  clinics  will  depend  on  the  direct  needs  of 
the  district  served  by  the  out-patient  department.  In  most  large  dispensaries 
certain  clinics  are  usually  maintained,  as  the  children's  clinic,  general  medi- 
cal, general  surgical,  gynecological,  genito-urinary,  skin,  eye,  ear,  nose  and 
throat.  To  these  other  clinics  are  being  added  which  have  already  demon- 
strated their  usefulness,  or  whose  necessity  becomes  more  and  more  ap- 
parent year  by  year,  as  the  orthopedic,  the  dental,  the  clinics  for  nervous 
and  mental  diseases,  and  the  physical  radio  and  hydro-therapy  clinics. 

In  providing  space  for  the  various  clinics  care  should  be  taken  to  avoid 
locating  close  together  those  having  a  very  large  attendance,  as  this  would 
inevitably  lead  to  overcrowding  in  that  part  of  the  building.  It  must  also 
be  kept  in  mind,  however,  that  it  is  desirable  to  have  as  small  a  number 
of  patients  as  possible  dependent  upon  the  elevator,  and  the  upper  floors 
should  therefore  be  reserved  for  the  clinics  with  the  smallest  number  of 
patients.  The  largest  number  of  patients  would  attend  the  general  medi- 
cal and  children's  clinics,  and  it  is  advisable  that  these  should  be  located 
on  the  first  floor,  even  though  this  might  tend  to  produce  congestion,  be- 
cause there  would  naturally  be  a  greater  number  of  officials  and  attendants 
on  the  first  floor,  and  because  it  is  inadvisable  to  have  too  many  children 
make  use  of  the  elevator.  The  surgical  clinic  should  be  placed  on  the 
second  floor,  and  the  others  located  so  as  to  secure,  as  nearly  as  possible, 
an  equal  distribution  of  patients  over  the  whole  building.  Consideration 
should  also  be  given  to  the  special  requirements  of  each  clinic,  such  as 
quiet,  and  good  light,  where  most  needed. 

In  planning  the  rooms  for  each  clinic  one  of  three  types  may  be  chosen : 
the  room  may  be  made  large,  moderate  in  size,  or  very  small.  The  large 
room  enables  two  or  three  physicians  to  work  at  one  time,  with  screens 
separating  the  patients;  this  affords  ease  of  consultation  between  physi- 
cians, enables  one  man  to  handle  all  cases  in  an  emergency,  and  maJ<es  it 
possible  to  use  one  room  and  its  equipment  for  different  purposes.  The 
large  room,  however,  does  not  afford  the  quiet  necessary  for  certain  ex- 
aminations, nor  the  privacy  desirable  for  all  patients. 

A  single  small  room,  large  enough  to  hold  merely  the  physician  and  his 
patients,  has  many  advantages,  and  also  some  disadvantages  if  not  care- 
fully planned.  The  chief  advantage  is  privacy,  which  is  desirable  for  the 
patients,  and  enables  the  physician  to  do  better  work.  The  disadvantages 
are  that  small  rooms  require  more  space  than  larger  ones ;  consultations 
between  physicians  are  somewhat  difficult;  and  the  rooms  are  inelastic 
and  cannot  be  altered  as  circumstances  may  require. 


THE   OUT-PATIENT  DEPARTMENT 


499 


If  the  clinics  are  to  be  used  for  teaching  purposes,  however,  the  rooms 
should  be  of  moderate  size,  about  9x14  feet.  This  has  been  found  to 
be  suited  to  the  need  of  a  physician  or  surgeon  working  under  the  obser- 
vation of  a  small  group  of  students.  Even  if  the  out-patient  department 
is  not  organized  essentially  for  teaching  purposes  a  room  of  such  size  is 
not  extravagant,  facilitates  work,  and  allows  for  the  possibility  of  teach- 
ing being  made  a  feature  of  the  clinics  at  some  future  time. 

Genereil  Medical  Clinic 

Owing  to  the  large  attendance  at  this  clinic,  from  40  per  cent,  to  50 
per  cent,  of  the  total,  it  should  preferably  be  located  on  the  first  floor. 
Good  light  is  of  less  importance  here  than  in  other  clinics,  such  as  those 
for  skin  diseases  and  dentistry.  The  waiting-space  may  be  common  to 
both  sexes,  but  there  should  be  separate  examination  rooms  for  male  and 
female  patients.  A  room  may  be  set  aside  for  the  treatment  of  stomach 
cases,  and  other  specialization  may  be  found  desirable,  both  for  teaching 
purposes  and  for  attracting  specialists  in  certain  diseases. 

Children's  Clinic 

The  treatment  of  children's  diseases  has  become  a  specialty,  and  a 
clinic  for  children  should  be  maintained  separate  from  that  for  adult  medi- 
cal cases.  As  a  preventive  agency  in  the  development  and  spread  of  dis- 
ease the  children's  clinic  is  of  the  greatest  importance.  Here,  also,  will 
be  found  the  largest  number  of  infectious  cases  coming  to  the  dispensary, 
and  special  care  should  be  taken  to  guard  against  the  spread  of  such 
diseases. 

Surgical  cases,  skin  diseases,  and  other  special  cases  among  children 
may  be  treated  in  the  clinics  provided  for  adult  cases,  all  children  under 
seven  years  being  treated  in  the  female  rooms,  and  children  over  seven  in 
rooms  according  to  their  sex.  One  room  in  the  children's  clinic  should 
be  devoted  to  the  treatment  of  babies.  Diseases  of  infancy  should  be 
given  special  consideration  here,  and  mothers  instructed  in  feeding  and 
general  care  of  babies. 

Surgical  Clinic 

In  this  clinic  there  should  be  a  division  for  male  patients  and  another  for 
female  patients.  In  each  division  there  should  be  an  operating  room,  some- 
what larger  than  the  ordinary  treatment  room.  One  small  sterilizing  room 
should  be  provided,  and  in  each  division  rooms  might  be  set  aside  for 
fracture  cases,  for  the  dressing  of  clean  wounds,  and  for  septic  cases. 

Gynecological  Clinic 

The  careful  examination  and  treatment  of  these  cases  require  an  oper- 
ating room  with  equipment,  and  also  a  consultation  room,  where  prelimi- 
nary examination  may  be  made.  Owing  to  the  character  of  these  diseases 
it  is  especially  advisable  that  only  one  patient  at  a  time  should  be  admitted 
for  treatment. 

In  connection  with  this  clinic  a  room  should  be  devoted  to  obstetrics, 
where  special  treatment  for  such  cases  may  be  given,  together  with  in- 
struction in  prepartum  hygiene.  The  importance  of  this  clinic  in  connec- 
tion with  visiting  nursing  has  been  pointed  out  elsewhere. 


500  HOSPITAL   COMMITTEE 

Genito-urinary  Clinic 

It  is  desirable  to  locate  this  clinic  in  such  a  way  that  the  patients  will 
come  in  contact  with  the  patients  of  other  clinics  as  little  as  possible.  In 
addition  to  the  treatment  rooms,  and  rooms  for  the  preparation  of  cases, 
a  special  laboratory  for  blood  tests,  etc.,  is  desirable,  but  not  absolutely 
essential.  The  preponderance  of  opinion  seems  to  be  that  syphilitic  cases 
should  not  be  treated  here,  but  sent  to  the  skin  clinic. 

Dermatological  Clinic 

This  clinic  should  be  located  where  good  light  is  available.  One  room 
for  men  and  one  for  women  will  be  necessary,  and  if  syphilis  is  treated 
two  additional  rooms  will  be  required. 

Nose,  Throat  and  Ear  Clinic 

As  artificial  light  is  largely  used  in  the  work  of  this  clinic,  it  may  be 
located  where  the  natural  light  is  insufficient  for  other  clinics.  One  large 
room  may  be  used  for  this  clinic,  separated  by  partitions  into  the  desired 
number  of  compartments,  one  for  each  physician  in  attendance.  In  addi- 
tion there  should  be  a  small  operating  room  for  more  serious  cases.  Ton- 
sils and  adenoids  may  be  removed  in  this  clinic,  or  such  cases  may  be  sent 
to  the  hospital,  especially  if  they  are  to  be  kept  over  night. 

Eye  Clinic 

This  clinic  will  require  an  examining  room  at  least  20  feet  in  one  di- 
mension, for  testing,  and  also  an  operating  room  and  a  dark  room. 

Dental  Clinic 

The  relation  of  defective  teeth  to  other  disorders  is  well  recognized, 
and  medical  men  are  attaching  more  and  more  importance  to  the  proper 
care  of  the  teeth,  especially  in  children.  A  dental  clinic  with  two  rooms 
should  be  provided. 

Clinic  for  Nervous  and  Mental  Diseases 

Such  clinics  have  been  greatly  neglected  in  the  past  and  their  impor- 
tance much  underestimated.  This  is  shown  by  the  records  of  the  Easf 
Side  Clinic  for  Mental  Diseases,  at  295  Henry  Street,  and  by  records  of 
similar  clinics  at  Cornell,  Vanderbilt,  Bellevue,  and  others.  Such  clinics 
would  result  in  a  better  knowledge  of  mental  diseases  in  their  early  mani- 
festations, and  would  promote  the  discovery  and  treatment  of  many  men- 
tal cases  in  the  early  and  more  curable  stages.  At  present  too  many  cases 
of  insanity  do  not  come  under  treatment  until  they  are  well  developed. 

Orthopedic  Clinic 

The  correction  of  deformities  by  means  of  special  apparatus  and  exer- 
cise is  a  very  important  branch  of  modern  surgery  which  can  be  carried 
on  successfully  in  the  out-patient  department.  The  necessary  rooms  should 
be  provided  for  this  work,  and  may  well  be  located  in  the  basement. 


THE   OUT-PATIENT  DEPARTMENT  501 

Hydro-therapy  Clinic 

The  great  benefit  to  many  cases,  particularly  nervous  diseases,  of  thera- 
peutic treatment  makes  such  a  clinic  of  much  importance  in  the  organiza- 
tion of  an  out-patient  department.  The  entire  equipment  can  be  placed 
conveniently  in  the  basement. 

Physical  Therapy  Clinic 

Two  rooms  for  baking  apparatus  and  two  for  physical  massage  are 
necessary  for  this  clinic.  This  is  of  special  importance  in  the  organiza- 
tion of  the  dispensary,  as  it  enables  the  physicians  and  surgeons  to  secure 
for  the  patients  special  treatment  necessary  for  the  complete  cure  of  the 
disease  treated. 

Radio-therapy  Clinic 

A  room  with  apparatus  for  radio-therapy  should  be  provided,  for  rea- 
sons similar  to  those  above  stated. 

Contagious  and  Communicable  Diseases 

1.  Whooping-cough 

Increasing  attention  is  being  devoted  to  the  treatment  and  the  preven- 
tion of  whooping-cough,  recent  studies  by  United  States  public  health  offi- 
cials and  others  having  shown  the  large  rate  of  incidence  and  death  in 
this  disease.  It  is  advisable,  therefore,  that  there  should  be  an  isolated 
clinic  devoted  to  the  treatment  of  whooping-cough  cases,  since  in  many 
instances  the  early  stages  of  this  disease  can  be  effectually  treated  in  an 
out-patient  department. 

2.  Vaginitis 

The  infectious  nature  of  this  disease  has  led  many  surgeons  to  recom- 
mend separate  rooms  for  its  treatment  in  an  out-patient  department,  and 
this  has  been  done  in  several  instances,  with  beneficial  results.  The  clinic 
for  the  treatment  of  vaginitis  should  be  one  of  the  isolated  clinics. 

3.  Tuberculosis 

Tuberculosis  should  be  treated  strictly  as  an  infectious  disease,  in  order 
to  impress  upon  patients  its  serious  character.  The  rooms  for  this  clinic, 
therefore,  should  not  be  used  for  the  treatment  of  other  diseases,  and  it  is 
to  be  preferred  that  they  be  entirely  separate  from  the  other  clinics  and  a 
separate  entrance  provided.  In  estimating  the  number  of  rooms  for  this 
clinic  allowance  should  be  made  for  the  increase  in  attendance  that  will 
follow  effective  treatment.  The  roof  of  the  out-patient  department  may 
be  so  constructed  that  it  could  be  utilized  as  a  day  camp  for  tuberculous  pa- 
tients. 


SUPPLEMENT 

To  illustrate  the  foregoing  principles  and  considerations  there  are  sub- 
mitted herewith  floor  plans  adapted  to  a  typical  New  York  City  comer 
lot,  restricted  on  two  sides  by  buildings.  The  purpose  of  the  plans  pri- 
marily is  to  show  the  grouping  of  rooms ;  the  relation  of  rooms  to  the 
waiting  space ;  the  proportion  of  waiting  space  and  rooms;  the  relative 
sizes  of  rooms  used  for  different  purposes. 

The  plans  are  not  drawn  for  a  particular  hospital,  but,  taken  in  connec- 
tion with  the  material  in  the  memorandum,  they  should  be  of  service  in  de- 
signing such  a  department  for  any  public  hospital. 


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APPENDIX 


SUGGESTED  RECORDS 

Patients'  History  Cards 

The  patient's  history  cards  should  be  of  flexible  cardboard,  8  x  lo  inches, 
to  facilitate  filing  and  removal.  There  should  be  special  cards  for  each 
clinic,  with  the  items  appropriate  to  the  diseases  treated  therein,  and  each 
clinic  history  card  should  have  its  own  color  corresponding  to  the  color 
of  admission  card.  The  items  for  the  social  history  would  remain  the 
same  on  all. 

The  following  specimens  indicate  what  would  be  adequate  for  the 
general  medical  and  gynecological  clinics.  (Cards  for  the  other  clinics 
would  have  appropriate  wording,  and  diagrams  to  mark  the  location  of 
lesions,  etc.,  should  be  printed  on  the  tuberculosis  cards  and  on  any  others 
where  they  would  assist  in  a  clear  description  of  the  case.) 


Name 

Address:    Street 

OUT-PATIENT  DEPARTMENT 

. . .  Age. . . .  Mar.  State ] 

No Floor 

CASE  No 

Date 

STativity 

. . .  Care  of 

Home:  Number  of  Rooms Sink 

Names  of  Members  of  Family     Age 

1 

..  Toilet Art. 

Diseases 

Heat 

Work              Income 

2 

3 

4 

6 

6 

,  Insurance 

Total  IncoE 
Charitable 

Rent  Paid 

Relief 

S07 


5o8  HOSPITAL   COMMITTEE 

GENERAL  MEDICAL  CLINIC 

Dr DIAGNOSIS, 

Complications 

(Note  :     Whenever  possible  use  X  or  O  to  denote  the  presence  or  absence  of  a  characteristic.) 

Family  His.:     Tbc Neur Arth Cane Nephr Syph 

Patient's  His.:  Tbc Diph Scar.  F Typh Gout Rheum Malar 

Pneu .... 

Habits:    Tea Cups Coffee Cups Alch Tob S.  or  C 

Char,  of  food Mastication 

Pres.  hist,  began Onset:     Gradual Sudden ....     Free  inter .... 

Prob.  cause Symptoms  changed  

Headache Char Location Time  of 

Vertigo Nervousness Drowsiness Bad  taste Appetite 

Thirst Dysphagia Vomit. ...  of  blood Feeling  of  fullness of  weight 

of  discomfort Time  of 

Heartburn Time  of 

Pain Location Time  of Duration 

Affected  by  position by  food  or  drink Relieved  by Sympts.  ref.  to  circ. 

syst to  resp.  syst to  nerv.  syst 

to  g.  u.  syst Stools  reg Const Diar Color 

Blood Mucus Gen.  health  and  strength Loss  of  weight Sleep 

Remarks:    

Phys.  exam.:   Nourish Develop Weight Teeth Tongue 

Pupils:     Rt Lf React.  Ught Accom M.  M 

Color Anemic Glands Pulsetomin Irreg.inf 

Irreg.  in  r Tension  volume Vessel  not  thickened B.  P 

M.  M 

Heart:     P.  M.  I.  in i.  s inch,  from  M.  S.  L 

Sounds 

Lungs:     Expansion,  rt If Percus.  and  auscult 

Resp to  min 

Abdomen: Liver Spleen 

Stomach: Position Tenderness Tumor 

Bowels Rectum 

Nervous  System: Reflexes 

Test  Meal 

Urine 

Blood 

Feces 

Treatment 


(Reverse  Side) 

SUBSEQUENT  VISITS  > 
Date  Symptoms  and  physician's  signature  Treatment 


'  Additional  sheets,  if  necessary,  for  subsequent  visits  could  be  attached  to  the  original 
card.  The  wording  of  the  reverse  side  and  the  additional  sheets  would  be  the  same  for  the 
history  cards  of  all  the  clinics. 


THE   OUT-PATIENT  DEPARTMENT  509 

CASE  NO 

OUT-PATIENT  DEPARTMENT 

Date 


Name Age Mar.  State Nativity 

Address:   Street No Floor Care  of.. . 

How  long  at  present  address. 

Previous  address Occupation 


Home:  Number  of  Rooms Sink Toilet Art.  Heat 

Names  of  Members  of  Family      Age  Diseases  Work  Income 

1 

2 

3 

4 

8 

6 

Total  Income, 

Rent  Paid Insurance Charitable  Relief 


GYNECOLOGICAL  CLINIC 

Dr DIAGNOSIS. 

Complications. 


(Note:  Whenever  possible  use  X  or  O  to  denote  the  presence  or  absence  of  a  characteristic.) 

Family  His.:    Tbc Neur Arth Cane Neph Syph 

Patient's  His.:     Tbc Diph Scar.  F Typh Gout Rheum 

Malar Pneum Grip 

Operations:     Menses  began  at  ....  yrs.;  Every  ....  weeks;  Duration Flow 

Painfiil Last  period Preced.  period 

Married Yrs Children Oldest   Yovmgest    

Miscar 

Labors  and  puerperia:    Phys.  ex  vagina: Urethra Bartholin  glands 


Perineum:    Rupture 1st  degree 2d  degree 3d  degree 

Uterus:    Cervix  lacerated 

Position:    Antipledia Retroflexion Prolapse 

Ovaries:    Prolapsed Cystic Retrodisplaced 

Fallopian  tubes 

Test:    Urine Blood 

Treatment: 

Social  Service  Records 

The  visit  to  the  home  of  the  patient,  whether  merely  to  investigate  the 
financial  condition  or  to  administer  prescribed  treatment,  should  result  in 
securing  a  more  complete  account  of  the  patient's  social  environment  than 
was  possible  at  the  admitting  desk.  The  card  on  which  the  visiting  nurse 
enters  her  data  should  be  itemized  as  fully  as  possible,  to  save  time  in 
history  taking.  It  should  have,  in  addition,  space  for  recording  the  nursing 
done  in  the  home,  and  any  other  assistance  given.  The  sheet  should  be 
of  the  same  size  as  the  original  Social  and  Medical  History  Card,  so  that 
it  may  be  attached  to,  and  filed  with  that  card,  if  deemed  desirable. 


5IO  HOSPITAL  COMMITTEE 

SOCIAL  SERVICE  BUREAU 

CASE  NO 

OUT-PATIENT  DEPARTMENT 

Original  Case  No 

Clinic 

DIAGNOSIS 

Name Age Date 

Referred  by 

Address:     Street No Floor Care  of 

House:  (Ten.  Apt.  Lodg.  H.) Number  of  Stories 

Number  of  Families Gen.  cond.  of  bldg 

Cleanliness 

Home:     Number  of  rooms Lt Dark Dim Rooms  used  for  sleep- 
ing  

Cleanliness:     Sink Toilet Roof  available Art.  heat 

TheFamily:    Adults Children Boarders Who  cares  for  pt 

Family  cond. :  (neat,  careless,  dirty) Other  cases  in  family: 

Names  of  Members  of  Family      Age  Diseases  Work  Income 

1 

2 

3 

4 

6 


Total  Income 

Rent  paid Insurance Charitable  relief. 

Deviations  from  history  given  to  admitting  officer: 

Recommendation  of  Visiting  Nurse: 

Assistance  secured  by  Social  Service  Bureau: 

(Reverse  side) 

HOME  NURSING: 
Prescription  of  O.  P.  D.  doctor: 
Date Condition Treatment 


Admission  Cards 

I.  The  admission  card  should  be  of  stiff  cardboard,  about  2x3^ 
inches,  and  of  a  different  color  for  each  clinic.  A  difference  in  shades 
would  help  to  distinguish  cards  of  the  same  clinic,  to  be  used  for  different 
days  or  different  sessions.  For  instance,  if  red  were  the  color  for  the 
general  medical  clinic,  a  dark  red  would  be  used  for  Monday,  Wednesday, 
and  Friday  clinics,  and  a  light  red  for  the  Tuesday,  Thursday,  and  Satur- 
day clinics.  The  same  sort  of  differentiation  could  be  used  between  morn- 
ing and  afternoon  sessions,  so  that  the  admitting  attendant  could  im- 
mediately recognize  patients  appearing  at  wrong  hours  and  refuse  to  ad- 
mit them,  except  for  some  special  reason.  It  is  advisable  that  a  nominal 
fine  be  imposed  for  the  loss  of  a  card.  The  penalty  might  be  rescinded 
at  the  discretion  of  the  admitting  officer,  but  the  fact  of  a  fine  being  possi- 
ble would  make  the  patients  more  careful  and  would  prevent  the  loss  of 
time  entailed  in  reissuing  cards.  Following  is  a  specimen  of  the  facts  that 
should  appear  upon  the  printed  card: 


THE   OUT-PATIENT  DEPARTMENT  511 


ADMISSION  CARD  CHILDREN'S  CLINIC 

NO.  

CHILDREN'S   CLINIC 

Dr. 

Mondays,  Wednesdays,  Fridays 
9.30  to  11.30 

Always  Bring  This  Card  with  You 

A  fine  of  IOC.  will  be  imposed  for  loss  of   card 

(^Reverse  Side) 

OUT-PATIENT  DEPARTMENT 

Name : 
Address: 

Section  296,  Chapter  55, 
Consolidated  Laws. 

"Any  person  who  obtains  medical  or  surgical  treat- 
ment on  false  representation  from  any  dispensary 
licensed  under  the  provisions  of  this  act  shall  be 
guilty  of  a  misdemeanor  and  on  conviction  thereof 
shall  be  punished  by  a  fine  of  not  less  than  ten 
dollars,  and  not  more  than  two  hundred  and  fifty 
dollars." 

Imprisonment  until  fine  be  paid  may  be  imposed. 
Code  Crim.   Pro.,  Section  718. 


2.  In  addition  to  the  patient's  card,  which  would  be  in  the  patient's 
possession,  there  should  be  an  admission  check,  which  would  be  simply  a 
small  card,  1x2  inches,  colored  to  correspond  to  the  patient's  card,  and 
containing  only  the  name  of  the  clinic  and  the  number  of  the  patient,  is- 
sued in  order  of  appearance.  These  cards  would  be  issued  by  the  regis- 
tration clerk  to  every  patient  at  each  visit,  and  would  serve  to  keep  a 
regular  order  of  admission  of  patients  to  the  clinic  rooms.  The  registra- 
tion clerk  would  keep  a  record  of  the  number  of  new  and  old  patients 
admitted  to  each  clinic  room  at  each  session. 


512  HOSPITAL   COMMITTEE 

Form  for  Transfer  of  Patients  from  Hospital  to  Out-Patient  Department 

The  following  specimen  shows  a  form  for  this  purpose : 

Hospital 

Transfer  to  Out-Patient  Department 

Name Hospital  No 

Address Date 

Diagnosis 

Admitted  to  Ward Transferred  to  Ward 

Discharged  to  Out-Patient  Department  for 

Dr 

Approved  Supt 

Form  to  be  returned  from  O.  P.  D. 

Diagnosis Hospital  No 

Remarks:  

M.  D. 

(Doctor  treating  patient  in  O.  P.  D.) 

O.  P.  D.  No 

Stub  Hospital 

Transfer  to  Out-Patient  Department. 

Name Hospital  No Date 

Referred  to Clinic 

Reply  Received ,  191 .... 

M.  D. 

(To  be  retained  in  the  hospital.) 

Form  for  Transfer  of  Patients  of  Out-Patient  Department  to  the  Hospital 
The  following  specimen  shows  a  form  for  this  purpose  (sheet  should  be 
colored  corresponding  to  the  color  used  by  the  clinic  from  which  it  is 
issued)  : 

Out-Patient  Department 
Transfer  to  Hospital  or  to  Clinic 

No Date 

Name Address 

From Clinic 

_  /  CUnic 

^° \  Hospital 

Under  treatment  here  for. 

Referred  for  (  additional  diagnosis 
l  treatment 

Remarks: 

M.  D. 


To  be  returned  to  O.  P.  D. 

O.  P.  D.  No Hospital  No 

To Clinic. 

Diagnosis 

Remarks: 


.M.  D. 


Stub  Out-Patient  Department 

No Date Name 

Referred  to for. 

Reply  received ,  191 


.M.  D. 


(To  be  retained  in  clinic  or  O.  P.  D.) 


THE   OUT-PATIENT  DEPARTMENT 


S13 


Form  to  Accompany  Laboratory  Specimens 

The  physician  or  surgeon  who  sends  specimens  of  blood,  sputum,  etc., 
for  analysis,  should  send  with  each  specimen  a  slip  similar  to  the  fol- 
lowing : 


Out-Patient  Department 
Genito-urinary  Clinic 


Dr 

Patient's  name . 

1st  Specimen 
2nd       " 
3rd 


Date , 

Diagnosis. 


Blood 

Urine 

Sputum 

Pus  (side) 

Gastric  Contents 

Faeces 


To  be 

Examined 

for 


Laboratory  Report. 


Clinical  Microscopist 


Form  to  Accompany  Patient  to  the  X-Ray  Department 

The  following  specimen  shows  a  form  for  this  purpose: 

Out-Patient  Department 
General  Surgical  Clinic 

Patient's  name Date 

Referred  by  Dr Diagnosis 

To  X-Ray  Department 

^    ffluoroscopeUhe 

I  skiagrapn    J 

(Part  of  body) 
Special  point  for  consideration  by  the  X-ray  operator 


Patient  was  sldagraphed  or  fluoroscoped  on 

Reason  for  this  examination 

What  kind  of  dressings,  bandages,  splints  or  packings  has  patient? . 


Can  these  be  removed?. 


Form  for  Referring  Cases  from  Clinics  to  the  Social  Service  Bureau 

The  following  specimen  shows  a  form  for  this  purpose: 


Out-Patient  Department 
Children's  Clinic 


Name  of  Patient. 

Address 

Remarks 


Date 

Case  No.  . 
Diagnosis . 


Dr. 


514  HOSPITAL  COMMITTEE 

Form  for  Patients  Needing  Special  Dressings  or  Examination 

It  will  frequently  happen  that  a  patient  whose  injury  has  been  dressed, 
or  of  whom  an  examination  has  been  made,  will  need  an  additional  dress- 
ing or  reexamination  for  particular  symptoms  earlier  than  the  time  when 
the  physician  or  surgeon  who  originally  treated  the  patient  is  to  return^ 
For  instance,  a  surgeon  who  attends  his  clinic  on  Monday,  Wednesday, 
and  Friday,  may  on  Monday  treat  a  fracture  which,  in  his  opinion,  would 
require  redressing  on  Tuesday.  There  should  be  a  form  to  accompany 
the  patient  on  this  special  visit,  as  follows : 

Out-Patient  Department 

General  Surgical  Clinic 

Date 

Please  i     ^^ .      }  this  case day 

l  examine  J 

,  191. . . . 

Remarks 

Dr 


Statistics 

The  Registrar  would  keep  in  a  daily  loose-leaf  register  account  of  the 
number  of  patients  admitted  to  each  clinic,  according  to  diagnoses,  and  a 
general  account  according  to  clinics.  These  figures  would  be  secured 
from  the  record  cards,  which  would  be  returned  to  him  from  the  clinic 
rooms  before  distribution  to  the  files.  At  the  end  of  the  month  he  would 
send  the  sheets,  with  their  summaries,  to  the  Superintendent,  who,  after 
inspecting  them,  would  return  them  to  him  for  filing.  The  summaries 
would  be  combined  into  an  Annual  Report.  (Suggested  forms  are  shown 
on  pages  515  and  516.) 


S.& 


i  '^ 


-^     CO 

C  « 

o  g     o 
mo    w 


Si6 


HOSPITAL  COMMITTEE 

Monthly  Report  of  Attendance. 

OUT-PATIENT  DEPARTMENT 
Month 


1st 

2d 

Summary 

Clinics 

ll 

.a 
3'a 

3o 

Successive 

columns 

provide 

for  all  the 

days  in  the 

month 

1^ 

3  S 

3"3 

Gen.  Med.  Male 

Gen.  Med.  Female 

Gen.  Children 

Gen.  Surg.  Male 

Gen.  Surg.  Female 

Gynecological 
Skin 

Genito-urinary 
Etc. 

Total 

Annual  Report  of  Attendance. 

OUT-PATIENT  DEPARTMENT 
Year 


Jan. 

Feb. 

Summary 

Clinics 

11 

3o 

il 

o 

Successive 
columns 
provide 
for  all  the 
months  in 
the  year 

3 '3 

3  o 
e2 

>     a 

< 

Gen.  Med.  Male 
Gen.  Med.  Female 
Gen.  Children 
Gen.  Surg.  Male 
Gen.  Surg.  Female 
Gynecological 
Skin 

Genito-urinary 
Etc. 

Total 

THE   OUT-PATIENT  DEPARTMENT  517 

The  head  of  the  Social  Service  Bureau  would  report  monthly  to  the 
Superintendent  on  the  following  form,  the  summary  of  which  would 
comprise  the  Annual  Report: 

Monthly  Report  of  Social  Service  Bureau. 
Month Hospital 

Total  number  of  cases  investigated 

Number  of  cases  visited  at  home 

Number  of  cases  nursed  at  home 

Total  number  of  visits  for  nursing 

Number  of  cases  for  which  charity  relief  was  obtained 

Number  of  cases  treatment  refused 

Annual  Report  of_Social  Service  Bureau. 

Year Hospital 

Total  number  of  cases  investigated 

Number  of  cases  visited  at  home 

Number  of  cases  nursed  at  home 

Total  number  of  visits  for  nursing 

Number  of  cases  for  which  charity  relief  was  obtained 

Number  of  cases  treatment  refused 

From  the  register  signed  by  the  members  of  the  medical  staff  at  the 
time  of  arrival  and  departure,  the  Registrar  would  compile  the  following 
Report  of  Attendance  of  Doctors: 

MONTHLY  REPORT. 
Attendance  of  Doctors. 

Month 

Scheduled  Number  of         Number  of 

Clinics  Dr.  Pos.  Attendance  Days  Hours 

Days        Hours       Present  Present 

Medical,  Male Dr.  S. 

Dr.  P. 

Dr.  C. 

Dr.  P. 
Medical,  Female. .  .Dr.  S. 

Dr.  P. 

Dr.  C. 

Dr.  F. 
Medical,  Children. .  Dr.  S. 

Dr.  P. 

Dr.  C. 

Dr.  F. 
Surgical,  Male Dr.  S. 

Dr.  P. 

Dr.  C. 

Dr.  F. 
Surgical,  Female. .  .Dr.  S. 

Dr.  P. 

Dr.  C. 

Dr.  F. 
Gjmecological Dr.  S. 

Dr.  P. 

Dr.  C. 

Dr.  F. 
Etc. 


SICKNESS  IN  THE  HOME  AND   PROPOSED  HEALTH 
CENTER. 


THE  INVESTIGATION 

Study  of  Sickness  in  the  Home  in  Certain  Districts  of  New  York  City 

Necessity  for  Such  Study 

One  of  the  duties  that  the  City  of  New  York  has  assumed  is  the  care 
of  the  public  health.  Up  to  the  present  time,  except  for  the  hospitals  sup- 
ported entirely  or  in  part  by  the  City  funds,  the  work  has  been  preventive 
rather  than  curative.  The  Divisions  of  Contagious  and  Communicable 
Diseases  of  the  Department  of  Health  receive  and  disseminate  to  interested 
parties  reports  of  such  diseases.  In  addition,  they  employ  district  inspectors 
and  nurses  to  visit  cases  of  such  diseases  when  not  under  the  care  of  a 
private  physician,  in  order  to  see  that  proper  quarantine  is  maintained  and 
that  the  quarters  are  fumigated  upon  the  termination  of  each  case.  Actual 
care  of  the  sick  in  their  homes  for  these  or  any  other  diseases  has  not  yet 
been  attempted  by  the  City.  So  far  as  it  has  been  done  it  has  been  left 
to  the  initiative  of  private  charities. 

The  basis  of  this  study  is  the  assumption  that  in  order  to  control  disease 
it  is  necessary  for  the  City  to  have  at  least  an  approximate  knowledge  of 
the  amount  and  character  of  sickness  existing  during  any  year.  To  pre- 
scribe adequate  measures  of  relief,  or  even  of  safety,  without  such  knowl- 
edge would  be  exceedingly  difficult,  if  not  impossible.  The  present  agencies 
for  obtaining  this  information  are  inadequate.  The  Department  of  Health 
has  no  means  of  ascertaining  the  existence  of  contagious  and  communicable 
diseases,  except  from  the  reports  of  hospitals  and  private  physicians,  and 
although  a  legal  penalty  is  attached  to  the  failure  to  report  such  a  case,  it  is 
well  known  that  there  are  many  derelictions.  In  addition  to  these  there 
are  numerous  instances  where,  because  of  the  mildness  of  the  attack,  a 
physician  is  not  called  in,  and  practitioners  agree  that  the  danger  of  infection 
from  these  unattended  cases  is  very  great.  For  all  other  diseases  no  attempt 
is  made  to  discover  their  prevalence  or  effect. 

Method  of  Inquiry 

Several  methods  of  determining  this  question  were  considered  before 
adopting  the  one  pursued. 

A  house-to-house  canvass  over  the  entire  City  could  not  be  attempted, 
owing  to  the  expense,  and  it  was  decided  that  it  would  be  impracticable  to 
circularize  all  the  physicians  of  the  city ;  first,  because  many  of  them  would 
have  no  time  or  inclination  to  answer  circular  letters  of  inquiry,  and  of 
those  who  did,  many  would  lack  complete  records  of  their  cases;  second, 
because  by  this  method,  all  those  cases  in  which  the  services  of  a  physician 
were  not  used  would  be  missed,  these  latter  being  the  ones  it  was  particu- 
larly desired  to  reach.  Charity  organizations  and  relief  societies  could  give 
information  of  only  those  cases  in  which  relief  was  asked  for,  which  would 
be  an  inconsiderable  part  of  the  total. 

It  was  finally  determined  to  make  a  careful  calculation  of  sickness  at 
home  in  two  sections  of  the  City  and  supplement  this  by  a  house-to-house 

521 


522  HOSPITAL   COMMITTEE 

canvass  of  a  few  blocks  within  the  same  districts,  and  an  intensive  study  of 
some  one  disease.'  The  special  benefit  of  such  a  method  lay  in  the  possi- 
bility of  selecting  particular  sections  where,  because  of  unfavorable  living 
conditions,  or  the  poverty  or  ignorance  of  the  inhabitants,  it  would  seem 
especially  necessary  that  the  City  assume  control.  The  additional  informa- 
tion secured  by  the  house-to-house  canvass  and  the  study  of  one  disease 
would  serve  to  further  illuminate  the  situation. 

The  calculation  was  made  on  the  basis  of  deaths  from  zymotic  and  cer- 
tain other  preventable  diseases  as  recorded  in  the  Department  of  Health. 
The  Bureau  of  Records  classifies  these  deaths  by  wards.  During  the  year 
1910,  the  deaths  from  such  diseases  occurring  in  institutions  were  listed 
for  the  wards  in  which  the  institutions  were  situated,  so  that  by  consulting 
the  records  of  the  several  institutions  to  discover  the  number  of  deaths  of 
particular  diseases  occurring  in  them,  and  deducting  this  number  from 
the  total  reported  by  the  Department  of  Health,  the  number  of  deaths  oc- 
curring at  home  was  ascertained.  For  instance,  in  the  Seventh  Ward  90 
deaths  were  caused  by  pneumonia  during  1910,  and  as  68  of  these  were 
in  institutions,  22  were  listed  as  having  occurred  at  home.  Using  these 
figures  and  the  death  rate  of  this  disease  as  established  by  competent  authori- 
ties from  a  large  number  of  cases,  it  was  possible  to  arrive  at  an  estimate  of 
the  number  of  cases  of  pneumonia  that  ran  their  course  in  the  homes  of 
the  Seventh  Ward  residents  in  1910. 

After  the  year  1910,  the  Health  Department  listed  the  deaths  having 
occurred  in  institutions  from  certain  diseases  for  the  ward  in  which  the 
deceased  resided  previous  to  death.  This  method  of  recording  deaths  by 
residence  rather  than  by  institutions  made  it  impossible  to  ascertain  the 
number  of  deaths  having  occurred  at  home  without  consulting  the  individual 
death  certificates.  It  is  possible,  however,  to  estimate  with  a  considerable 
degree  of  accuracy  the  number  of  deaths  having  occurred  at  home  by  using 
the  statistics  of  1910  as  a  basis  and  adding  thereto  a  percentage  of  increase 
to  account  for  the  probable  number  of  deaths  in  191 1. 

Districts  Studied 

Two  sections  in  Manhattan  were  selected  for  study.  One  was  desig- 
nated as  Lower  East  Side  District,  within  the  area  bounded  on  the  east 
by  the  East  River,  on  the  north  by  East  Fourteenth  Street,  on  the  west 
by  Fourth  Avenue  to  Houston  Street  and  by  Broadway  from  Houston 
Street,  on  the  south  by  Park  Row,  Spruce  Street  and  Ferry  Street;  com- 
prising the  4th,  6th,  7th,  loth,  nth,  13th,  14th,  and  17th  Wards.  The 
other  section  was  designated  West  Side  District,  within  the  area  bounded 
on  the  west  by  the  Hudson  River,  on  the  north  by  West  Fortieth  Street,  on 
the  east  by  Sixth  Avenue,  on  the  south  by  West  Fourteenth  Street;  com- 
prising the  16th  and  20th  Wards. 

The  population  of  the  Lower  East  Side  District  in  1910  was  621,339,  an 
average  density  of  515  per  acre.  This  means  that  26.7  per  cent,  of  the 
entire  population  of  Manhattan  is  congregated  in  this  portion,  although 
it  is  only  9.4  per  cent,  of  the  area.  The  population  is  exceedingly  diverse 
in  point  of  nationality  and  in  other  characteristics ;  such  as  religion,  literacy, 
native  customs,  etc.  In  a  locality  receiving  annually  so  large  an  influx  of 
immigrants  as  this  a  lack  of  knowledge  of  American  institutions  must  be  a 
prominent  feature.     Ignorance  of  personal  sanitation  must  also  be  present. 

'  This  last  idea  was  later  abandoned  because  of  its  infeasibility. 


SICKNESS  IN   THE   HOME 


523 


The  West  Side  District  is  of  a  different  type.  The  area  selected  is 
smaller,  about  6.3  per  cent,  of  Manhattan,  and  contains  5.5  per  cent,  of 
the  entire  population,  an  average  density  of  163  per  acre._  The  people 
here  are  largely  native  Americans,  a  considerable  number  having  been  bom 
in  the  district  where  they  reside.  There  are  many  features  here,  such  as  the 
Tenderloin  District,  that  make  it  interesting  for  a  study  of  disease  condi- 
tions. 

Sickness  Based  on  Health  Department  Statistics 

Lower  East  Side  District 

The  general  estimate  indicates  that  there  were  about  145,236  cases  of 
sickness  in  this  section  during  1910 — 234  per  1,000  of  population.  Of  these, 
89.4  per  cent,  were  treated  at  home  and  10.6  per  cent,  in  institutions.  The 
129,771  cases  at  home  produced  a  total  of  3,604,900  days  of  sickness,  about 
ten  times  as  many  as  for  the  corresponding  period  in  hospitals. 

TABLE   I. 
Sickness  in  a  Lower  East  Side  District  in  1910. 


Z'5 


s.s 

J3  to 


J  I  3 


3B2 
pK.S 


Typhoid  Fever 

Scarlet  Fever 

Diphtheria 

Pneumonia 

Broncho-pneumonia 

Cerebrospinal   Meningitis 

Measles 

Whooping-cough   

Diarrhosal  Diseases 

Pulmonary  Tuberculosis. 
Other  Diseases 

Total 


127 
216 
530 
730 


685 

718 

3,680 


172 

485 

478 

465 

232 

SO 

466 

167 

4,730 

1,4501: 

6,750 


306 
2,000 
2,400 

2,600  1 

2,980  / 

136 

5,066 

1,133 

34,250 
3,900 

75,000 


15,300 
96.000 
72,000 

100,440 
1,360 

126,650 
39,650 

342,500 

936,000 
1,875.000 


5,160 
16,975 
11,472 

9,758 

400 

8,990 

4,175 

38,000 

174,000 

101,250 


478 
2,485 
2,878 

f  3,065 

I  3,212 

186 

5,532 

1,300 

39.000 
5,350 

81,750 


15,465 


129,771 


3,604,900 


370,180     145,236 


460 
l,484t 
2,144 
2,740 
2,850 
157 
6,534 
1,300 

28,800 
4,172 

88,780 


139,421 


1  of  every  4  of  the  population  was  sick. 

89.4  per  cent,  of  all  cases  of  sickness  were  cared  for  at  home  and  10.6  per  cent,  were  in  institutions. 

*  This  estimate  was  based  on  the  average  percentage  of  cases  of  typhoid  fever  and  diphtheria  that  are 
taken  to  hospitals. 

t  The  ratio  used  in  estimating  the  1910  cases  was  not  used  for  1911,  as  there  was  an  epidemic  of  scarlet 
fever  in  this  section  during  1910. 

J  The  basis  of  this  estimate  was  that  the  ratio  of  the  number  of  deaths  occurring  in  this  district  bore  the 
same  ratio  to  deaths  in  hospitals  as  the  ratio  of  the  number  of  cases  of  tuberculosis  in  this  district  bore  to  the 
number  in  the  entire  City.  The  other  basis  was  not  used  because  the  deaths  from  this  disease  at  home  repre- 
sent a  large  number  of  cases  that  were  in  institutions  at  some  time  previous  to  their  death. 


Typhoid  fever  caused  44  deaths  in  this  district  during  1910,  of  which 
16  were  in  institutions  and  28  at  home.  The  death  rate  of  this  disease,  as 
determined  from  over  25,000  cases  in  large  cities  of  America  and  Europe, 
is  9.3  per  cent.  The  calculation,  therefore,  is  that  there  were  over  300 
cases  of  typhoid,  or  65  per  cent,  of  the  total,  at  home  and  about  172,  or 
35  per  cent.,  in  institutions ;  a  total  of  more  than  470.  As  the  charts  of 
the  Health  Department  show  only  271  cases  reported  from  this  section  dur- 


524 


HOSPITAL   COMMITTEE 


ing  1910  the  conclusion  is  that  more  than  30  per  cent,  of  the  cases  were 
not  reported  to  the  Department.  This  is  a  conservative  estimate,  since  the 
9.3  per  cent,  death  rate  is  taken  largely  from  the  statistics  of  hospitals, 
where,  because  the  more  severe  attacks  of  typhoid  are  cared  for  in  hospitals, 
the  rate  would  be  higher  than  in  the  general  run  of  cases.  Osier,  in  his 
"System  of  Medicine,"  puts  the  death  rate  for  typhoid  not  in  hospitals  as 
low  as  5  per  cent.  The  5  per  cent,  rate  would  mean  that  there  were  560 
cases  of  typhoid  in  the  homes  in  this  district  in  the  year  1910. 

Using  the  first  estimate,  however,  in  the  more  than  300  cases  in  the 
homes,  it  was,  of  course,  impossible  to  discover  at  what  stage  a  physician 
was  called  in,  if  at  all.  How  much  of  the  illness  from  this  disease  could 
have  been  prevented,  or,  at  least,  modified  in  intensity  by  adequate  City 
supervision  is  a  question  of  deep  significance.  "Too  often,"  says  Dr.  Thos. 
McCrae,  speaking  of  the  private  physician  with  a  typhoid  patient,  "he  does 
not  reaHze  his  own  responsibility,  and  is  thoroughly  satisfied  if  he  brings 
the  patient  well  through  the  attack,  heedless  of  the  danger  to  the  com- 
munity." Of  more  importance,  however,  is  the  fact  of  the  large  number 
of  cases  not  reached  by  any  physician. 

There  were  158  deaths  caused  by  scarlet  fever  in  the  Lower  East 
Side  District,  of  which  31,  or  19  per  cent.,  were  in  institutions,  and  127,  or 
81  per  cent.,  at  home.  At  a  death  rate  of  6.4  per  cent.,  a  rate  determined 
by  a  study  of  statistics  bearing  on  over  133,000  cases  from  private  and  hos- 
pital practice  in  New  York,  Boston,  and  London,  these  127  deaths  meant 
that  there  were  about  2,000  cases  of  scarlet  fever  in  the  homes  in  this 
section  during  1910.  The  duration  of  this  disease  is  from  34  to  48  days, 
so  that  according  to  this  estimate  there  were  from  68.000  to  96,000  days  of 
care  and  attendance  needed  in  this  section  for  scarlet  fever  alone.  The 
danger  lies  in  the  fact  that  this  necessary  supervision  is  not  given;  that 
there  are  a  great  many  cases  dismissed  from  the  superficial  care  of  ignorant 
or  preoccupied  relatives  before  desquamation  has  been  completed,  a  period 
when  the  patient  is  of  greatest  danger  to  the  community. 

There  were  216  deaths  from  diphtheria,  or  84  per  cent.,  at  home  in  this 
district  in  1910,  and  43,  or  16  per  cent.,  in  institutions.  The  average  death 
rate  of  this  disease  in  New  York  during  the  past  ten  years  has  been  g 
per  cent.  On  the  continent  of  Europe,  according  to  Prinzing's  "Medi- 
zinische  Statistik,"  the  rate  is  much  higher,  13.8  per  cent.,  but  this  probably 
is  due  to  the  fact  that  there  is  not  as  wide  a  use  of  the  diphtheria  antitoxin 
there  as  here.  Using  9  per  cent,  as  the  death  rate  of  New  York  City,  the 
216  deaths  meant  that  there  were  about  2,400  persons  ill  in  their  homes 
from  this  disease  in  the  Lower  East  Side  District,  which  would  be  equal  to 
about  27  per  cent,  of  the  total  number  reported  from  the  entire  Borough 
of  Manhattan.  On  the  basis  of  an  average  duration  of  30  days  this  esti- 
mated number  of  cases  resulted  in  about  72,000  days  of  sickness. 

Pneumonia  and  broncho-pneumonia  together  caused  1,412  deaths  in  this 
section.  Of  these,  95  died  of  pneumonia  in  institutions,  and  57  of  broncho- 
pneumonia, so  that  there  were  530  deaths  of  pneumonia  and  730  of  broncho- 
pneumonia in  the  homes.  A  comparative  study  of  over  525,000  reported 
cases  in  American  and  European  countries  shows  a  death  rate  of  20.4  per 
cent,  for  pneumonia  and  24.5  per  cent,  for  broncho-pneumonia.  These 
rates  have  remained  almost  stationary  during  the  past  15  years.  There 
were,  therefore,  about  2,600  cases  of  pneumonia,  85  per  cent,  of  all,  in 
the  homes  in  this  section  during  1910,  and  about  465,  or  15  per  cent.,  in 
institutions  ,*  a  total  of  3,065.     There  were  about  2,980  cases  of  broncho- 


SICKNESS  IN   THE  HOME  525 

pneumonia,  or  93  per  cent.,  in  the  homes,  and  232,  or  7  per  cent.,  in  insti- 
tutions; a  total  of  3,212.  This  estimate  of  5,580  cases  in  the  homes  meant 
from  55,800  to  100,000  days  of  sickness,  based  upon  the  usual  duration 
of  from  10  to  18  days.  Overcrowding  and  bad  ventilation,  hunger  and 
cold  are  strong  predisposing  causes.  Unhygienic  conditions  in  general  in- 
crease both  the  number  of  cases  and  the  duration  of  the  disease.  The 
United  States  census  report  shows  that  whites  of  foreign  birth  are  much 
more  frequently  attacked  by  these  lung  diseases  than  native  whites.  That 
all  these  factors  are  active  in  the  Lower  East  Side  District  is  evidenced 
by  the  fact  that  the  number  of  deaths  here  from  pneumonia  and  broncho- 
pneumonia was  28  per  cent,  of  the  total  for  Manhattan. 

Of  the  7,835  deaths  in  this  district  during  1910,  3,394  were  of  children 
under  5  years  of  age,  a  proportion  of  43  per  cent,  of  the  total.  For  the 
entire  City,  exclusive  of  this  section,  the  proportion  of  deaths  of  children 
under  5  to  the  total  number  of  deaths  was  30  per  cent.  This  extraordinarily 
large  death  rate  for  children  in  the  Lower  East  Side  District  makes  espe- 
cially interesting  a  study  of  measles,  whooping-cough,  and  infantile  diarrhoea 
in  this  section,  these  being  the  principal  diseases  of  childhood. 

There  were  83  deaths  caused  by  measles  in  this  section,  of  which  76  were 
at  home  and  7  in  institutions.  The  average  death  rate  in  New  York  for 
this  disease  is  2.5  per  cent.,  but  this  is  evidently  too  high,  as  it  is  based 
on  reported  cases  only.  Prinzing,  in  his  "Medizinische  Statistik,"  gives 
1.5  per  cent.,  which  would  seem  more  nearly  correct.  At  this  rate  it  was 
estimated  that  there  were  over  5,500  cases  of  measles  in  this  section,  or 
38  per  cent,  of  the  total  number  reported  from  Manhattan.  The  cases  in 
the  homes,  estimated  at  more  than  5,000  cases,  or  92  per  cent,  of  all,  pro- 
duced a  total  of  at  least  125,000  days  of  sickness. 

Whooping-cough  caused  39  deaths  in  this  section,  of  which  5  were  in 
institutions.  During  normal  periods  the  death  rate  of  this  disease  is  3  per 
cent.,  which  means  that  there  were  over  1,100  cases  of  whooping-cough  in 
the  homes,  or  88  per  cent,  of  all,  and  about  170,  or  12  per  cent.,  in  institu- 
tions; a  total  of  about  1,300  cases.  With  an  average  duration  of  35  days, 
this  estimated  number  of  cases  caused  nearly  40,000  days  of  sickness  at  home 
in  this  section.  The  terrific  virulence  of  whooping-cough  when  not  under 
control  (Kutlinger  reports  a  death  rate  of  48  per  cent,  during  an  epidemic) 
would  seem  to  make  necessary  a  greater  degree  of  supervision  over  these 
cases  at  home  than  is  now  feasible. 

From  a  study  of  infantile  diarrhoea  which  Dr.  Kirly  made  in  the  tene- 
ment district  of  New  York,  he  derived  a  death  rate  of  2  per  cent,  for  this 
disease.  In  the  Lower  East  Side  District  there  were  720  deaths  from  diar- 
rhoeal  diseases  among  children  under  5  years  of  age,  of  which  685  were  in 
the  homes  and  35  in  institutions.  This  would  mean  that  there  were  about 
34,250  cases  in  the  homes,  or  88  per  cent,  of  all,  and  4,750,  or  12  per  cent., 
in  institutions ;  a  total  of  39,000.  With  an  average  duration  of  8  to  10  days, 
it  was  estimated  that  there  were  from  274,000  to  342,500  days  of  sickness  at 
home  from  this  one  infants'  disease. 

Educative  work  regarding  diseases  of  children  has  done  much  within 
the  past  ten  years  to  decrease  the  infant  death  rate.  Certainly  it  is  reason- 
able to  suppose  that  with  additional  preventive  measures  and  actual  treat- 
ment of  the  sick  children  at  home  the  number  of  deaths  could  be  reduced  to 
as  absolute  a  minimum  as  is  humanly  possible  and  the  degree  of  sickness, 
in  a  large  percentage  of  cases,  greatly  decreased  in  intensity. 

Pulmonary  tuberculosis  caused  the  deaths  of  751  persons  in  this  section 


526 


HOSPITAL   COMMITTEE 


during  1910,  of  which  33  were  in  institutions  and  718  at  home.  A  study  of 
tuberculosis  in  this  section  showed  a  death  rate  of  18.6  per  cent. — that  is, 
18.6  per  cent,  of  all  those  who  have  tuberculosis  die  in  the  course  of  a  year. 
These  718  deaths  at  home,  then,  indicated  that  there  were  about  3,900  cases 
of  tuberculosis  in  the  Lower  East  Side  District  homes.  More  will  be  said 
of  this  disease  upon  another  page. 

Besides  these  deaths  from  cases  of  principal  diseases,  there  were  3,680 
deaths  from  other  causes  in  the  homes  in  this  section.  These  included  dis- 
eases of  the  digestive,  respiratory,  circulatory,  genito-urinary,  and  nervous 
systems,  skin  diseases  and  all  others.  It  was,  of  course,  impossible  to  esti- 
mate with  any  degree  of  accuracy  the  number  of  cases  of  sickness  that  these 
3,185  deaths  represented,  since  almost  none  of  these  diseases  follow  any 
well  defined  course,  and  each  case  has  a  distinct  history  of  its  own.  How- 
ever, we  may  assume  that  a  very  large  number  of  cases — certainly  over 
75,000 — with  a  great  many  days  of  sickness — from  1,000,000  to  1,125,000 — 
occurred  in  this  section  to  cause  the  more  than  3,000  deaths  from  miscel- 
laneous diseases. 

West  Side  District 

The  total  of  47,885  cases  of  sickness  in  this  section  during  1910,  repre- 
senting a  rate  of  incidence  of  more  than  i  out  of  3 — 371  per  1,000  of  popu- 
lation— is  very  much  larger  than  that  of  the  Lower  East  Side  District. 
The  relative  amount  of  sickness  at  home  and  in  the  hospitals  also  varies 
from  that  of  the  East  Side  District.  Only  2,569  of  these  West  Side  cases,  or 
5.4  per  cent,  of  the  total,  were  treated  in  hospitals,  remaining  there  for  a 
total  of  116,711  days.  The  cases  at  home  caused  a  total  of  1,427,265  days 
of  sickness. 

TABLE   II. 
Sickness  in  a  West  Side  District  in  1910. 


.a. 2 


Is  33 


•2S 


'■Saw 


II 


III 


|K.a 


Typhoid  Fever 

Scarlet  Fever 

Diphtheria 

Pneumonia 

Broncho-pneumonia .  . . . 

Measles 

Whooping-cough   

Diarrhceal  Diseases  .  .  _. . 
Pulmonary  Tuberculosis 
Other  Diseases 

Total 


187 

369 

1.4S7 


108 

391 

567 

7351 

714  / 

800 

367 

9.350 

1,984 

30,300 


5,400 
18.768 
17.010 


26,082 

1,820 

20,000 

12.845 

93,500 

476.160 

757,500 

1,340 

3.325 

0 

82.560 

18,900 

216 

485 

656 

/      828 

i       751 

S67 

500 

9.350 

2,672 

41,560 


45,316 


57,885 


216 

300 

490 

870 

650 

1,000 

700 

6,350 

2,080 

18.320 


30,976 


1  of  every  3  of  the  population  was  sick. 

78.3  per  cent,  of  all  cases  of  sickness  were  cared  for  at  home  and  21.7  per  cent,  were  in  institutions. 

*  Cases  of  tuberculosis  in  institutions  from  this  district  were  estimated  as  in  Table  I. 

There  were  20  deaths  from  typhoid  fever  in   1910,  of  which   10  were 
at  home  and   10  in  institutions.  There  were,  therefore,   108  cases  in  the 


SICKNESS  IN   THE  HOME  527 

homes  and  108  cases  in  institutions,  a  total  of  216  cases,  with  about  5,400 
days  of  sickness  at  home.  On  the  charts  of  the  Health  Department  only 
158  cases  were  reported  from  this  section,  leaving  about  27  per  cent,  of 
the  cases  not  reported. 

Scarlet  fever  caused  31  deaths;  6  in  institutions  and  25  at  home.  This 
would  mean  about  485  cases  of  sickness  from  this  disease;  94,  or  19  per 
cent,  of  all,  in  institutions  and  391,  or  81  per  cent.,  at  home.  These  391 
cases  estimated  to  have  been  at  home  caused  about  19,000  days  of  sickness. 
This  is  a  conservative  estimate,  since,  undoubtedly,  in  a  great  majority  of  the 
cases,  the  course  of  the  disease  was  abnormally  prolonged  by  the  lack  of 
proper  attention  or  unhygienic  conditions.  On  the  other  hand,  there  were 
probably  many  cases  permitted  to  be  about  before  the  disease  had  ended. 

During  the  year  diphtheria  caused  59  deaths  in  this  section ;  8  in  insti- 
tutions and  51  at  home,  which  would  mean  that  there  were  about  90  cases  of 
diphtheria,  or  13  per  cent,  of  all,  in  hospitals  and  570,  or  87  per  cent.,  at 
home,  and  that  the  latter  caused  more  than  17,000  days  of  sickness. 

There  were  353  deaths  from  pneumonia  and  broncho-pneumonia.  Of 
these,  19  died  of  pneumonia  in  institutions  and  9  of  broncho-pneumonia, 
leaving  150  deaths  from  pneumonia  and  175  from  broncho-pneumonia  at 
home,  which  would  mean  735  cases  of  pneumonia,  or  89  per  cent,  of  all, 
and  714  cases  of  broncho-pneumonia,  or  95  per  cent.,  in  the  homes.  This 
estimated  number  of  1,449  cases  resulted  in  over  26,000  days  of  sickness. 
Over  6.5  per  cent,  of  the  total  number  of  deaths  from  these  diseases  in 
Manhattan  occurred  in  this  district. 

The  deaths  of  children  under  5  years  of  age  were  25.1  per  cent,  of  the 
total  number  of  deaths.  This  percentage  is  considerably  lower  than  the 
percentage  of  such  deaths  for  the  entire  City,  which  is  31.6  per  cent.  The 
same  decrease  also  appears  in  the  estimated  cases  of  children's  diseases. 
There  were  13  deaths  from  measles;  12  at  home  and  i  in  a  hospital,  which 
would  mean  about  70  cases,  or  7  per  cent,  of  all,  in  institutions  and  800 
cases,  or  93  per  cent.,  at  home,  which,  it  was  estimated,  resulted  in  about 
20,000  days  of  sickness.  Whooping-cough  caused  4  deaths  in  institutions 
and  II  at  home,  which  would  mean  about  140  cases  in  institutions  and 
360  at  home.  These  latter,  it  was  estimated,  were  sick  for  a  total  period 
of  about  13,000  days. 

According  to  the  estimate,  no  diarrhceal  cases  were  taken  from  this  sec- 
tion to  institutions  during  the  year,  but  187  died  at  home;  there  were,  there- 
fore, about  9,400  cases  of  the  disease  at  home,  with  a  total  of  over  94,000 
days  of  sickness. 

The  death  rate  for  tuberculosis  in  this  district  is  somewhat  higher  than 
in  the  Lower  East  Side  District — 19.  i  per  cent.,  as  compared  with  18.6  per 
cent.  At  this  rate,  the  369  deaths  at  home  and  14  in  institutions  would  mean 
that  there  were  about  2,000  cases  at  home,  which,  it  is  estimated,  caused 
over  476,000  days  of  sickness. 

The  remaining  1,487  deaths  at  home  caused  by  other  diseases  would 
mean  that  there  were  25,000  cases  of  sickness,  with  probably  more  than 
500,000  days  of  illness. 

Comparisons  of  West  Side  and  Lower  East  Side  Districts 

The  population  of  the  West  Side  District  was  20.8  per  cent,  of  the 
other;  that  is,  the  Lower  East  Side  District  contained  nearly  5  times 
as  many  people,  with  about  3  times  the  density  of  population.    The  total 


528  HOSPITAL   COMMITTEE 

number  of  cases  of  sickness  in  the  West  Side  District  was  33  per  cent, 
of  the  other,  and,  therefore,  in  proportion  to  the  population,  there  was  more 
than  one  and  one-half  times  as  much  sickness  on  the  West  Side.  The  larger 
percentage  of  sickness  was  in  the  homes — 94.6  per  cent,  in  the  West  Side 
District  and  89.4  in  the  Lower  East  Side  District.  It  was  also  found  that 
there  were  proportionately  twice  as  many  days  of  sickness  at  home  in  the 
West  Side  District  as  in  the  other  section. 

There  was  45  per  cent,  as  much  typhoid  fever  in  the  West  Side  District 
as  in  the  Lower  East  Side  District — more  than  twice  as  much,  propor- 
tionately. Of  the  other  principal  diseases  there  were,  in  proportion  to 
the  population,  about  an  equal  number  of  cases  of  scarlet  fever,  diphtheria, 
and  broncho-pneumonia.  Pneumonia  was  somewhat  more  prevalent  in  the 
West  Side  District,  there  having  been  27  per  cent,  as  many  cases  with  only 
20  per  cent,  as  much  population.  The  greatest  contrast  was  in  the  cases 
of  tuberculosis,  of  which  there  were,  proportionately,  3  times  as  many  in 
the  West  Side  District  as  there  were  in  the  other  section. 

The  proportion  of  deaths  of  children  under  5  years  of  age  to  the  total 
number  of  deaths,  which  was  25  per  cent,  in  the  West  Side  District,  was 
considerably  lower  than  the  43  per  cent,  in  the  East  Side  District,  but  this 
does  not  necessarily  mean  a  lower  death  rate  for  children  in  the  former. 
It  represents  chiefly  a  difference  in  the  actual  number  of  small  children  in 
the  two  sections.  As  will  be  observed  in  the  account  of  the  results  of  the 
house-to-house  investigation,  a  large  proportion  of  the  population  of  the 
West  Side  District  consists  of  unattached  men  and  women — boarders, 
lodgers,  etc. — and  to  this  fact  is  principally  due  the  smaller  proportion  of 
children's  deaths.  This  is  borne  out  by  the  fact  that  the  percentage  of 
deaths  from  diarrhceal  diseases  and  whooping-cough,  these  being  diseases 
principally  of  childhood,  was  by  no  means  lower  in  the  West  Side  District, 
there  having  been  23  per  cent,  as  many  as  in  the  East  Side  District  from 
diarrhceal  diseases  and  38  per  cent,  from  whooping-cough,  with  only  20 
per  cent,  as  much  population.  The  percentage  of  measles  cases  in  the 
West  Side  District  was  somewhat  lower,  only  16  per  cent.,  while  the  num- 
ber of  cases  of  other  diseases  in  this  section  was  38  per  cent,  of  the  total 
for  the  East  Side  District,  which  was  almost  twice  as  much,  proportion- 
ately. 

The  chief  value  of  this  comparison  lies  in  the  fact  that  it  shows  clearly 
the  necessity  of  considering  the  different  sections  of  the  City  separately.  The 
sections  here  studied  were  selected  as  being  similar  in  character,  so  far  as 
type  of  population  and  condition  of  homes  were  concerned,  and  the  differ- 
ence in  amount  and  kind  of  sickness  present  in  the  two  districts  indicates 
plainly  that  in  planning  remedial  or  supervisory  measures  the  necessities  of 
each  particular  section  should  be  clearly  in  mind.  Pulmonary  tuberculosis 
appears  to  be  3  times  as  prevalent  in  the  West  Side  as  in  the  East 
Side  District.  There  were  63  per  cent,  as  many  cases  in  the  West  Side 
District  with  only  20  per  cent,  as  much  population ;  yet  the  East  Side  District 
has  three  tuberculosis  clinics  to  supply  its  needs,  while  the  West  Side 
District  has  only  one.  Similar  differences,  with  corresponding  lack  of 
provision,  are  present  in  connection  with  other  diseases.  It  is  plainly  evi- 
dent that  individual  needs  must  be  studied  and  provision  made  for  them. 
This  need  for  individual  attention  appears  more  clearly  in  the  results  of  the 
house-to-house  canvass. 


SICKNESS  IN   THE   HOME  529 

Results  of  Personal  Investigation  in  the  Homes 

Lower  East  Side  District 

A  representative  portion  of  the  East  Side  District  was  selected;  within 
the  area  bounded  by  Stanton  Street  on  the  north,  Broome  on  the  south, 
Allen  on  the  east,  and  Chrystie  on  the  west  (the  exact  location  of  the  section 
investigated  is  shown  in  Diagram  i  accompanying  Table  III),  and  investi- 
gators visited  every  family  for  the  purpose  of  learning  the  conditions  relat- 
ing to  illness  in  the  section  during  the  year  1912. 

The  questions  asked  covered  the  following  points :  Sickness  in  the  home 
without  professional  attendance;  visits  of  private  physician;  visits  to  public 
clinics ;  cases  taken  to  hospitals ;  visits  of  Health  Department  officials  to 
the  home  for  quarantine  or  fumigation;  etc.  In  addition  to  these,  social 
facts  were  also  collected;  such  as  age  and  sex  of  patient;  condition  of 
dwelling  place;  number  in  family;  and  number  of  rooms  occupied  by  fam- 
ily. Six  hundred  and  sixty-two  families,  with  an  average  of  5  in  each 
family — in  exact  figures,  3,375  people — were  visited.  Of  these,  600  had  been 
sick  during  the  year;  an  average  of  about  i  out  of  6,  or  178  per  1,000  of 
population.  The  number  removed  to  hospitals  was  59,  or  9.6  per  cent,  of 
the  total,  and  541,  or  91.4  per  cent.,  were  sick  at  home. 

A  comparison  of  the  streets  investigated  shows  a  marked  contrast  in 
the  number  of  cases.  On  Delancey  Street  42  of  262  people,  or  160.3  P^^ 
1,000  of  population  were  sick;  on  Eldridge  Street  98  of  516,  or  189.9  P^r 
1,000;  on  Rivington  Street  80  of  595,  or  151. 2  per  1,000;  on  Forsyth  Street 
240  of  1,418,  or  169.2  per  1,000;  on  Broome  Street  81  of  584,  or  138.6  per 
1,000.  The  average  length  of  the  periods  of  illness  also  varied;  68  days 
on  Delancey  Street;  91  days  on  Eldridge  Street;  122  days  on  Rivington 
Street;  80  days  on  Forsyth  Street;  and  52  days  on  Broome  Street. 

It  is  interesting  in  relation  to  these  facts  to  consider  the  character  of 
the  homes  on  these  streets.  The  home  conditions  on  Eldridge  and  Riving- 
ton streets  were  of  the  worst  description.  Congestion  and  filth  were  pres- 
ent more  prominently  in  the  tenements  on  these  two  streets  than  anywhere 
else  in  the  section.  Inner  dark  rooms,  some  with  absolutely  no  means  of 
ventilation  except  the  door,  and  others  with  small  windows  opening  on 
closed  shafts,  were  found  in  the  buildings  of  this  character.  Forsyth  street 
was  of  the  same  general  character  of  half  of  the  section  investigated; 
namely,  the  block  between  Delancey  and  Rivington  streets,  where  most  of 
the  houses  have  but  one  sink  and  toilet  on  each  floor,  used  in  common  by 
all  the  families.  The  other  half,  between  Rivington  and  Stanton  streets, 
contained  houses  in  much  better  sanitary  condition.  There  was  less  conges- 
tion on  Delancey  Street — an  average  of  only  1.3  persons  to  a  room — with 
correspondingly  more  favorable  living  conditions.  The  best  houses  were 
on  Broome  Street.  Here  the  entire  block  contains  tenements  of  new  style, 
built  since  the  construction  of  the  Williamsburgh  Bridge.  The  rooms 
are  well  lighted  and  ventilated,  and  each  family  apartment  has  its  individual 
toilet  and  sink — features  lacking  on  the  other  streets.  The  decreased  aver- 
age number  of  days  of  sickness  may  not  be  a  direct  consequence  of  better 
living  conditions,  but  the  striking  coincidence  throughout  this  street  is  at 
least  worth  noting. 

There  were  125  confinements  during  the  year  in  these  two  blocks,  which, 
for  the  population  of  3,375,  made  a  birth  rate  of  38.5  per  1,000.  The  birth 
rate  for  the  entire  City  was  26.2.  Of  these  125  births,  116  were  in  the 
homes,  and  38  of  the  latter,  or  33  per  cent.,  were  attended  by  midwives, 


530  HOSPITAL   COMMITTEE 

the  mothers  in  these  cases  being  Italians ;  74,  or  63  per  cent.,  were  attended 
by  physicians,  the  mothers  being  Jewish ;  and  in  the  other  4  cases  both  mid- 
wife and  doctor  were  in  attendance.  The  average  number  of  days  of  con- 
finement was  9,  with  a  total  of  1,020  days.  In  9  cases,  7.2  per  cent,  of  all, 
delivery  took  place  in  hospitals;  the  total  number  of  days  for  these  was  105, 
making  an  average  of  12  days. 

The  average  of  9  days  of  confinement  in  the  cases  at  home  include  all 
the  time  of  the  midwives'  or  doctors'  visits.  As  a  matter  of  fact,  most  of 
these  women  were  up  and  doing  the  household  work  after  only  2  or  3 
days  in  bed.  Many  of  them  returned  to  outside  work  in  5  days  or  a  week. 
This  condition,  coupled  with  the  fact  that  33  per  cent,  of  the  cases  (in  the 
Italian  section  this  percentage  would  be  much  larger)  are  attended  by  mid- 
wives,  who  are,  necessarily,  less  able  to  prescribe  recuperative  remedies 
than  a  physician,  would  seem  to  account  for  the  prevalence  of  women's 
diseases  in  this  section.  There  were  33  cases  of  women's  diseases  at  home 
with  an  average  period  of  217  days  sickness,  and  7  in  hospitals  with  an 
average  of  21  days.  None  of  these  cases  were  of  specific  infection,  being 
chiefly  displacement  of  organs  or  general  disability.  If  the  connection  here 
suggested  is  true,  it  would  seem  that  32  per  cent,  of  the  women  confined  are 
later  incapacitated  by  resulting  diseases  for  extremely  long  periods. 

The  57  cases  of  stomach  disorders  during  the  year  resulted  in  a  total  of 
7,703  days  of  sickness,  an  average  of  135  days  for  each  case.  Only  2  cases, 
or  about  4  per  cent,  of  the  whole,  were  removed  to  hospitals,  where  they 
remained  for  a  total  of  70  days.  Under  this  heading  are  included  all  cases 
of  diarrhoeal  diseases,  constipation,  etc.,  as  it  was  impossible  in  gathering 
the  data  to  keep  the  distinctions  clear.  Appendicitis  occurred  in  6  cases,  of 
which  4  were  treated  in  hospitals,  where  they  remained  for  a  total  of  130 
days,  an  average  of  33  days  for  each  case.  The  2  cases  at  home  were  ill 
for  a  total  of  49  days. 

Diseases  of  the  respiratory  system  were  the  most  prevalent  of  all  the  ail- 
ments in  this  section.  There  were  142  cases,  or  43  per  1,000  of  population, 
with  a  total  incapacitation  of  4,007  days.  Keeping  in  mind  the  general 
house  conditions  on  the  streets  studied  and  described  in  a  previous  para- 
graph, it  is  interesting  to  classify  these  diseases  under  their  names  with 
the  rate  of  incidence  on  each  street  as  follows : 

Grippe  occurred  in  78  cases,  with  a  total  of  923  days  of  sickness.  Of 
these,  there  were  4  cases,  or  15.2  per  1,000  of  population,  on  Delancey 
Street,  with  an  average  of  8  days  of  sickness;  12,  or  23.3  per  1,000,  on  El- 
dridge  Street,  with  an  average  of  8  days;  8,  or  13.4  per  1,000,  on  Rivington 
Street,  with  an  average  of  20  days ;  45,  or  31.8  per  1,000,  on  Forsyth  Street, 
with  an  average  of  13  days.  There  were  10  cases  of  pneumonia,  with  a  total 
of  310  days  of  sickness.  Of  these  there  were  no  cases  on  Delancey  Street; 
I  case  was  on  Eldridge  Street,  with  9  days  of  sickness;  2  on  Rivington 
Street,  with  an  average  of  14  days;  4  on  Forsyth  Street,  with  an  average 
of  22  days ;  and  3  on  Broome  Street,  with  an  average  of  62  days.  There 
were  11  cases  of  bronchitis,  with  a  total  of  536  days  of  sickness.  Of  these, 
there  were  no  cases  on  Delancey  Street ;  2  cases  on  Eldridge  Street,  with  an 
average  of  44  days  sickness;  no  cases  on  Rivington  Street;  7  cases  on 
Forsyth  Street,  with  an  average  of  60  days ;  and  2  cases  on  Broome  Street, 
with  an  average  of  14  days.  Inflammations  and  other  affections  of  the 
throat  occurred  in  43  cases,  with  an  average  of  52  days  of  sickness  in  each 
case.  Of  these,  4  were  on  Delancey  Street,  5  on  Eldridge  Street,  10  on 
Rivington  Street,  13  on  Forsyth  Street,  and  11  on  Broome  Street. 


SICKNESS  IN   THE   HOME  531 

Rheumatism  was  present  in  this  section  in  a  large  number  of  cases,  at 
the  rate  of  10.9  per  1,000  of  population.  There  was  i  case  on  Delancey 
Street,  with  21  days  of  sickness;  6  on  Eldridge  Street,  with  an  average  of 
191  days;  6  on  Rivington  Street,  with  an  average  of  363  days;  20  on  For- 
syth Street,  with  an  average  of  239  days;  and  4  on  Broome  Street,  with 
an  average  of  279  days. 

There  were  9  cases  of  diphtheria,  at  the  rate  of  2.7  per  1,000  of  popula- 
tion, which  approximated  the  condition  throughout  the  City ;  the  rate  of 
incidence  for  this  disease  for  the  entire  City  during  1912  being  2.6  per  1,000. 
Of  these  9  cases,  7  were  in  the  homes  and  2  were  taken  to  the  hospital. 
There  were  19  cases  of  measles,  or  5.6  per  1,000;  a  rate  somewhat  lower 
than  that  for  the  entire  City,  which  was  7.5.  Of  these  19  cases,  17  were 
sick  at  home,  for  an  average  of  29  days,  and  2  were  removed  to  the  hos- 
pital, for  an  average  stay  of  35  days.  Scarlet  fever  was  more  prevalent  in 
this  section  than  the  other  infectious  diseases,  the  23  cases,  or  6.2  per  1,000, 
representing  almost  three  times  as  great  a  rate  of  incidence  as  that  for  the 
entire  City,  which  was  2.4  per  1,000.  Of  the  23  cases,  18  were  in  the 
homes,  for  an  average  of  44  days,  and  5  were  removed  to  hospitals,  for  an 
average  of  42  days.  Whooping-cough,  which  is  estimated  by  the  United 
States  Public  Health  Service  as  having  a  rate  of  incidence  of  about  100  per 
100,000,  occurred  in  this  section  in  9  cases,  all  at  home,  at  the  rate  of  270 
per  100,000.  There  were  19  cases  of  tuberculosis,  17  at  home  and  2  in 
hospitals;  but  it  is  probable  that  this  does  not  represent  the  total  number, 
as  there  was  considerable  reticence  in  acknowledging  the  presence  of  this 
disease  in  the  family.  Two  cases  of  spinal  meningitis,  or  0.6  per  1,000,  oc- 
curred in  this  section  during  1912. 

Diseased  conditions  of  the  eye,  all  of  which  had  been  treated  at  home, 
were  found  in  17  cases,  or  5  per  1,000  of  population,  with  an  average  of 
107  days  sickness:  affections  of  the  ear  in  10  cases,  or  3  per  1,000;  of 
which  8  were  sick  at  home,  for  an  average  of  149  days  in  each  case,  and  2 
in  hospitals,  for  an  average  of  11  days:  heart  disease  in  9  cases,  or  2.7  per 
1,000;  of  which  8  were  sick  at  home,  with  an  average  of  183  days,  and  i  in 
a  hospital,  for  21  days:  disorders  of  the  blood  in  9  cases,  or  2.7  per  1,000; 
all  of  which  were  treated  at  home,  with  an  average  of  15  days :  skin  diseases 
in  9  cases,  or  2.7  per  1,000,  with  an  average  of  69  days  sickness :  fractures 
in  9  cases,  or  2.7  per  1,000;  of  which  7  were  treated  at  home,  with  an  aver- 
age of  75  days,  and  2  in  hospitals,  for  an  average  of  25  days :  scattering 
cases  of  epilepsy,  erysipelas,  typhoid,  diabetes,  etc.,  of  which  30  were  sick 
at  home,  for  a  total  of  292  days,  and  23  in  hospitals,  for  a  total  of  527  days. 

Unsanitary  conditions  in  the  home  exercise  a  depressing  effect  upon  the 
sick  person,  which  is  increased  in  many  cases  by  the  poverty  and  ignorance 
of  the  people.  Unable  to  employ  a  private  doctor  and  unwilling  to  go  to 
the  hospital,  large  numbers  of  the  sick  attempt  to  find  relief  at  the  dispen- 
saries. Many  families  have  the  nominal  services  of  their  lodge  physician, 
but  the  people  do  not  seem  to  place  much  confidence  in  these  doctors  and 
seldom  call  them.  Where  the  disease  is  of  a  serious  nature  they  call  in  a 
private  doctor  if  they  can  afford  it,  or  visit  a  dispensary,  but  in  most  cases 
they  resort  to  home  treatment,  which  usually  is  of  the  crudest  sort. 

Entire  neglect  of  the  sick  often  results  from  various  causes.  At  297 
Broome  Street  a  woman  65  years  old  was  confined  to  her  bed  by  chronic 
rheumatism,  with  no  one  to  attend  to  her  because  all  the  other  members  of 
the  family  were  at  work.  In  the  same  house  a  woman  80  years  old  had 
been  in  bed  2  years  because  of  general  debility,  with  no  one  to  attend  to 


532  HOSPITAL   COMMITTEE 

her  during  the  day.  At  171  Eldridge  Street  and  156  Forsyth  Street,  chronic 
cases  of  bronchitis  and  rheumatism  were  without  treatment.  At  179  Eld- 
ridge Street,  a  husband  and  wife  afflicted  with  chronic  heart  trouble  for 
over  a  year  and  unable  to  move  about  had  been  without  treatment  of  any 
sort.  In  the  next  house,  No.  177,  two  children,  2  and  9  years  old,  re- 
spectively, were  covered  v/ith  open  sores  of  some  eruptive  disease.  Noth- 
ing had  ever  been  done  for  them  because  the  mother  was  "afraid  of  dis- 
pensaries." Many  cases,  whose  external  characteristics  plainly  indicated 
tuberculosis,  had  never  had  the  attention  of  any  medical  person,  and  were 
being  treated  with  home  remedies  or  neglected  entirely.  There  were  more 
than  50  persons  ill  from  fevers,  infections,  etc.,  requiring  medical  aid  and 
not  receiving  any. 

A  public  dispensary  in  such  a  community  is  of  very  great  importance. 
The  people  are  willing  to  go  to  a  dispensary  with  their  ailments  provided 
good  treatment  is  afforded.  Of  the  600  cases  of  sickness  found  in  the  sec- 
tion, 194,  or  32.3  per  cent.,  had  visited  dispensaries,  whereas  only  9.8  per 
cent,  of  the  cases  received  treatment  in  hospitals.  But  of  these  dispensary 
cases,  56,  or  29  per  cent.,  went  only  once  because  the  unbearable  conditions 
discouraged  them  from  another  attempt ;  and  of  the  others,  80,  or  40  per 
cent.,  had  been  unable  to  obtain  any  relief  upon  repeated  visits.  The  chief 
complaints  made  by  the  people  of  this  section  were  that  the  dispensaries 
are  so  overcrowded  that  patients  must  wait  for  hours,  and  that  the  ex- 
aminations they  receive  are  superficial  and  seldom  give  relief.  In  some  of 
the  dispensaries  many  patients,  sometimes  as  high  as  fifteen  or  twenty,  are 
crowded  into  one  small  room,  and  the  physician  hurries  from  one  to  the 
other  dispensing  prescriptions.  At  the  apothecary's  window  the  patients 
very  often  wait  two  or  three  hours  before  the  prescriptions  are  filled.  One 
experience  of  this  kind  usually  serves  to  prevent  the  return  of  the  timid 
ones,  or  of  those  who  are  unable  to  spend  half  a  day  on  a  dispensary  visit. 

That  the  dispensaries  are  inefficient  is  the  common  belief  among  almost 
all  of  the  people  in  this  section.  Actual  cases  are  furnished  to  support  this 
opinion.  One  woman,  at  303  Broome  Street,  whose  child  was  suffering 
from  burns,  said  that  the  dispensary  treatment  was  so  careless  that  blood- 
poisoning  developed  and  she  had  to  pay  $50  to  a  private  physician  to  have 
the  child  cured.  In  a  case  of  eye  trouble  in  a  child  living  at  154  Forsyth 
Street,  the  mother  was  told  at  a  dispensary  that  "nothing  was  the  matter," 
but  acute  inflammation  developed  later  and  an  operation  was  performed  by 
a  private  doctor.  Charges  are  also  made  that  in  some  of  the  dispensaries  the 
doctors  exploit  the  patients ;  ignorant  persons  are  told  that  the  disease  can- 
not be  cured  at  the  dispensary  and  that  the  patient  must  come  to  the  doc- 
tor's private  office,  at  a  certain  price  per  visit. 

The  efficiency  of  the  public  dispensary  has  been  treated  more  fully  in  an- 
other part  of  this  Report  which  deals  with  the  condition  in  one  of  the  dis- 
pensaries maintained  by  the  City. 

Middle  West  Side  District 

The  section  of  this  district  selected  for  personal  investigation  of  sick- 
ness at  home  included  the  block  bounded  by  Seventh  and  Eighth  Avenues, 
and  35th  and  36th  Streets;  35th  Street  between  Ninth  and  Tenth  Avenues; 
and  Tenth  Avenue  between  34th  and  3Sth,  and  36th  and  37th  Streets  (the 
exact  location  of  the  section  investigated  is  shown  in  Diagram  II  accom- 
panying Table  IV).     The  information  sought  covered  the  same  points  as 


SICKNESS  IN   THE  HOME  533 

the  investigation  of  the  East  Side  District.  A  total  of  464  families,  with 
an  average  of  4  in  each  family — 1,959  people,  to  be  exact — were  visited. 
Of  these,  405  had  been  sick  during  the  year,  an  average  of  about  i  out  of 
S,  or  206  per  1,000  of  population.  The  number  removed  to  hospitals  was 
50,  or  12.3  per  cent,  of  the  total  cases  of  sickness;  and  355,  or  87.7  per  cent., 
were  sick  at  home.  The  percentage  of  hospital  cases  was  larger  than  that 
for  the  East  Side  section,  a  condition  somewhat  at  variance  with  the  esti- 
mates made  for  the  entire  districts  (Tables  I  and  II).  The  other  estimates, 
as  to  the  relative  total  number  sick  and  the  relative  number  of  cases  of 
certain  diseases,  were  effectively  borne  out  by  the  results  of  the  house-to- 
house  canvass. 

The  house  conditions  throughout  this  section  are  extremely  bad.  The 
very  worst  are  on  the  north  side  of  35th  Street  between  7th  and  8th  Ave- 
nues, where  the  houses  are  three-story  tenements,  very  dilapidated  and  filthy, 
and  with  rear  tenements  of  the  same  noisome  character.  In  several  of 
these  houses  the  toilets,  used  in  common  by  all  the  families  on  a  floor,  were 
out  of  order,  causing  sickening  odors  throughout  the  building.  Defective 
plumbing  in  many  cases — this  condition,  according  to  the  report  of  the  ten- 
ants, having  been  present  for  several  years — had  resulted  in  rotten  floors 
and  hallways,  with  accompanying  odors  and  immediate  danger  of  accidents. 
The  basements  occupied  in  most  of  the  houses  by  two  or  four  families  were 
uniformly  dark,  damp,  and  filthy.  In  many  instances  one  section  of  the 
basement  was  used  as  a  depository  for  garbage,  with  one  or  two  families 
occupying  the  adjoining  section.  It  is  difficult  to  depict  the  squalor  found 
in  this  section.  Personal  and  moral  cleanliness  seemed  to  be  very  lightly 
regarded  throughout,  and  disorderly  living  quite  common.  In  many  cases 
the  occupants  of  the  house  comprised  a  male  or  female  head  of  the  "family," 
with  a  large  number  of  boarders  or  lodgers. 

There  were  58  cases  of  confinement  in  this  section  during  the  year,  mak- 
ing for  the  population  of  1,959  a  birth  rate  of  29.6  per  1,000,  which  was 
8.9  less  than  the  rate  in  the  East  Side  section.  Of  the  58  cases,  56,  or  97 
per  cent.,  were  at  home,  for  an  average  of  9  days  each ;  and  2,  or  3  per  cent., 
went  to  hospitals,  for  a  total  of  25  days. 

The  relatively  small  number  of  births  may  have  in  some  measure  af- 
fected the  number  of  cases  of  women's  diseases.  There  were  12  cases  of 
these  in  the  homes,  none  of  them  being  of  specific  infection,  with  an  average 
of  210  days  sickness ;  and  i  in  a  hospital,  for  9  days.  The  total  cases  aver- 
aged 6.6  per  1,000. 

That  unsanitary  living  conditions,  together  with  the  consequent  debili- 
tated constitutions,  are  strong  predisposing  causes  for  diseases  of  the  respira- 
tory system  is  a  fact  so  generally  accepted  as  to  hardly  need  repetition.  In 
this  block  the  prominence  of  such  diseases  makes  it  impossible  to  avoid 
associating  them  directly  with  the  exceedingly  imfavorable  home  environ- 
ment. There  were  88  cases  of  pneumonia,  bronchitis,  pleurisy,  asthma,  etc., 
or  44.4  per  1,000  of  population,  with  an  average  of  43  days  sickness  in 
each  case,  which  was  almost  twice  as  much  as  the  rather  large  average  in 
the  East  Side  District.  If  pulmonary  tuberculosis  be  included  in  this  classi- 
fication, as  there  is  good  reason  for  believing  it  should,  the  disease  rate  di- 
rectly traceable  to  home  conditions  amounted  to  53.1  per  1,000,  with  an 
average  sickness  of  58  days.  Of  these,  11  per  cent,  were  taken  to  hospitals 
and  89  per  cent,  were  sick  at  home. 

Rheumatism  also,  as  in  the  East  Side  section,  was  highly  prevalent  in 
this  section,  but  in  still  greater  proportion ;  there  having  been  20.9  cases  per 


534  HOSPITAL  COMMITTEE 

i,ooo  of  population  (as  compared  with  the  10.9  per  1,000  in  the  East  Side 
District),  with  an  average  length  of  189  days  sickness  for  those  cases  that 
were  in  the  homes,  or  90.1  per  cent,  of  all,  and  an  average  of  61  days  for 
the  9.9  per  cent,  that  were  removed  to  hospitals. 

Diseases  of  the  digestive  organs  occupied  a  principal  position  among  the 
ailments  in  this  section.  There  were  60  cases,  which  means  the  remarkably 
large  rate  of  incidence  of  30.7  per  1,000  of  population  (12.3  greater  than  in 
the  East  Side  District),  with  a  total  of  4,610  days  sickness,  with  an  average 
of  yy  days  in  each  case.  Of  the  60  cases,  6,  or  10  per  cent.,  were  in  hos- 
pitals for  a  total  of  245  days. 

Diphtheria  occurred  in  12  cases,  the  rate  of  incidence,  6.1  per  1,000, 
being  more  than  twice  as  great  as  that  for  the  entire  City.  Measles  also  had 
a  large  incidence  in  this  section,  having  been  9.2  per  1,000,  which  was  1.7 
more  than  the  entire  City  rate.  The  rate  for  scarlet  fever,  2  per  1,000,  was 
slightly  less  than  that  for  the  City.  Whooping-cough  occurred  at  the  rate 
of  I  per  1,000,  which  was  equal  to  the  estimate  for  the  entire  country.  The 
16  cases  of  tuberculosis  found,  very  probably,  as  in  the  East  Side  District, 
did  not  represent  the  true  total.  There  were  6  cases  of  chickenpox,  or  3.1 
per  1,000,  with  an  average  of  24  days  sickness. 

Neglect  of  the  sick  is  a  more  common  occurrence  in  this  section  than  in 
the  East  Side  District.  A  large  part  of  the  population  consists  of  un- 
attached men  and  women  lodgers,  and  families  of  two  or  three  members,  a 
situation  in  which  it  is  almost  impossible  for  a  patient  to  receive  adequate 
attention.  The  idea  of  going  to  a  hospital  occurs  to  most  of  these  people 
only  as  a  last  resource.  Their  dislike  for  hospital  treatment  is  very  deep- 
seated,  and  is  based  on  current  rumors  of  mistreatment  in  hospitals  and  gen- 
eral inefficiency.  The  antipathy  toward  the  public  dispensary  is  even 
stronger  here  than  in  the  East  Side  District.  Only  21  per  cent,  of  those 
who  were  sick  had  ever  visited  a  dispensary,  as  compared  with  the  32.3  per 
cent,  in  the  East  Side  District,  and  of  these,  15.3  per  cent,  went  only  once. 
They  complained  of  abusive  language,  lack  of  examination,  and  inefficient 
treatment. 


SUGGESTED  HEALTH  CENTERS 

The  foregoing  estimate  and  examination  of  sickness  in  the  home  make 
it  reasonably  clear  that  there  is  a  large  amount  of  sickness  which  could  be 
alleviated  or  prevented  by  a  reasonable  amount  of  supervision  on  the  part 
of  properly  constituted  agents.  It  is,  of  course,  an  open  question  how  far 
the  City  should  go  in  attempting  to  prevent  and  care  for  disease.  Thus  far 
the  sole  function  of  the  hospital  has  been  to  receive  and  treat  the  sick. 
Little  attempt  has  been  made  to  inquire  into  the  contributory  causes  of  sick- 
ness, except  contagions ;  nor  has  sickness  been  followed  from  the  hospital 
to  the  home  in  an  attempt  to  further  relieve,  except  in  a  very  limited  degree. 
Such  work  of  prevention  as  is  carried  on  by  the  City  is  being  performed 
by  the  Health  Department.  This  Department,  in  addition  to  watching  the 
milk  and  water  supply  and  controlling  contagions,  examines  school  children 
for  contagion,  maintains  milk  depots,  a  few  clinics  for  tuberculosis,  and 
regulates  midwifery. 

The  City  has  assumed  the  responsibility  of  caring  for  sickness  when  it 
reaches  a  stage  needing  hospital  treatment  and,  within  certain  limits,  for 
the  prevention  of  contagious  disease.  Any  theory  of  social  obligation  which 
warrants  the  City  in  undertaking  the  care  and  prevention  of  sickness  would 
warrant  its  going  still  further,  if  its  finances  would  permit.  For  instance, 
the  City  is  maintaining  a  poHce  patrol  on  the  watersheds  to  prevent  pollu- 
tion; is  maintaining  laboratories  for  the  examination  of  drinking  water;  is 
providing  inspectors  to  examine  the  dairies  throughout  the  districts  from 
which  milk  is  shipped  to  New  York  City ;  and  closely  follows  any  outbreak 
of  typhoid  epidemic.  Such  cases  of  typhoid  as  do  appear,  if  application  is 
made,  are  received  into  municipal  hospitals  and  there  cared  for.  The  ex- 
amination of  health  conditions  made  by  this  Committee,  however,  shows 
that  out  of  44  deaths  by  typhoid  in  the  district  examined  on  the  East  Side, 
16  occurred  in  institutions  and  28  at  home.  It  appears  that  65  per  cent,  of 
the  typhoid  sickness  was  in  the  homes  and  35  per  cent,  in  the  hospitals. 
How  these  cases  of  typhoid  were  cared  for,  we  have  no  means  of  knowing. 
It  is  probable  that  in  nearly  all  cases  private  physicians  were  in  attendance, 
but  how  carefully  these  private  physicians  guarded  conditions  in  the  home 
to  prevent  the  spreading  of  this  contagion,  we  do  not  know.  Judging  by 
reports  from  quite  a  number  of  families,  typhoid  became  epidemic  in  certain 
households. 

The  Inspectors  of  the  Department  of  Health  visit  homes  in  connection 
with  certain  contagions  to  make  certain  that  the  cases  are  cared  for  by  pri- 
vate physicians,  but  seldom  more  than  one  or  two  visits  are  made.  From 
these  brief  visits  it  is  impossible  to  gain  a  clear  knowledge  of  the  conditions 
that  are  maintained  in  the  household  during  such  contagion.  It  was  noted 
by  the  foregoing  examination  that  in  the  East  Side  Section  there  were  about 
127  cases  of  scarlet  fever  cared  for  at  home,  216  of  diphtheria,  and  76  cases 
of  measles.  Judging  by  the  reports  of  the  field  inspectors  of  this  Com- 
mittee, in  a  number  of  cases  there  was  reasonably  clear  evidence  indicating 
that  these  contagions  had  spread  to  other  members  of  the  family  or  to 
neighboring  families.  Aside  from  those  contagions  recognized  as  quaran- 
tinable,  there  were  about  730  cases  of  pneumonia  in  the  homes,  38  cases  of 

535 


536  HOSPITAL  COMMITTEE 

spinal  meningitis,  and  34  cases  of  whooping-cough,  which  diseases  are  gen- 
erally recognized  as  infectious.  What  precautions  were  taken  against  the 
spreading  of  the  infection  is  unknown. 

From  the  examination  of  the  results  of  treatment  at  Gouverneur  Hos- 
pital, shown  upon  previous  pages  in  this  Report,  it  was  discovered  that 
about  one-third  of  the  persons  visiting  the  Out-Patient  Department  for  the 
first  time  did  not  return  for  subsequent  treatment.  The  explanation  given 
by  many  who  were  interviewed  as  to  the  reason  for  not  returning  was  that 
they  were  badly  treated  at  the  Out-Patient  Department.  These  people 
seemed  to  be  under  the  impression  that  their  cases  were  too  hastily  or  inade- 
quately diagnosed,  or  that  a  lack  of  sympathy  was  shown,  or  for  other 
reasons  they  were  displeased  with  the  handling  of  their  cases.  In  many 
instances  cited  in  that  part  of  this  Report  referred  to  above,  the  treatment 
was  evidently  inadequate,  and  required  the  attention  of  physicians  subse- 
quent to  the  visit  made  to  the  Out-Patient  Department.  It  is  a  great  waste 
of  work  to  treat  cases  but  once  in  an  out-patient  department  when  a  cure 
can  be  effected  only  by  continued  treatment,  and  it  would  seem  reasonable 
that  efforts  should  be  made  to  induce  such  persons  to  return  to  the  out- 
patient department  for  subsequent  treatment. 

None  of  New  York  City's  municipal  out-patient  departments  has  nurses 
who  can  follow  cases  to  the  homes.  Such  follow-up  work  has  been  carried 
on  for  several  years  by  the  Boston  Dispensary  and  by  the  Out-Patient  De- 
partment of  the  Presbyterian  Hospital  in  this  City.  The  Boston  Dispensary 
reports  that  the  average  number  of  visits  of  each  patient  has  been  increased 
from  3.1  to  4.54  since  the  introduction  of  the  follow-up  system.  The  Pres- 
byterian Hospital  authorities  feel  very  confident  that  their  system  of  send- 
ing nurses  to  the  homes  has  resulted  in  the  cure  of  a  great  many  cases  that 
otherwise  would  have  attended  the  Out-Patient  Department  but  once,  with 
ensuing  unsatisfactory  results.  The  outlay  necessary  to  maintain  the  follow- 
up  system  in  connection  with  both  the  Boston  Dispensary  and  the  Presby- 
terian Hospital,  in  the  opinion  of  the  governing  bodies  of  these  institutions, 
is  justified  by  the  results  obtained.  Undoubtedly  the  work  of  the  out-patient 
departments  of  the  municipal  hospitals  in  New  York  City  likewise  would  be 
greatly  improved  if  these  departments  would  follow  their  cases  to  the 
homes. 

If  the  City  of  New  York  is  justified  in  spending  money  for  the  cure  of 
disease,  it  would  seem  the  part  of  economic  wisdom  to  spend  money  for  its 
prevention.  Undoubtedly  a  larger  percentage  of  disease  could  be  prevented 
than  is  now  the  case  if  a  more  thorough  system  of  home  visitation  existed 
for  the  purpose  of  regulating  the  sanitary  conditions  surrounding  home 
treatment,  and  for  the  purpose  of  informing  all  citizens  of  means  and  meth- 
ods of  maintaining  sanitary  and  healthful  conditions.  How  far  the  City 
should  undertake  such  a  program  of  work  is  yet  problematical.  The  meth- 
ods of  doing  such  work,  its  cost,  and  the  results  to  be  obtained,  cannot  be 
determined  without  experimentation.  The  City  ought  to  try  an  experiment 
in  a  small  district,  and  in  a  limited  way,  to  determine,  if  possible,  whether 
or  not  such  work  could  advantageously  be  performed  by  the  City  as  a  regu- 
lar part  of  the  work  of  the  Health  Department  and  the  hospitals.  It  should 
undertake  this  experiment  also  to  determine  whether  or  not  a  large  portion 
of  sickness  can  be  cared  for  at  home  more  cheaply  than  in  expensive  hos- 
pitals. 

This  work  could  be  undertaken  by  physicians  and  nurses  from  Bellevue, 
and  also  physicians,  nurses,  and  inspectors  from  the  Department  of  Health. 


SICKNESS  IN  THE  HOME  537 

If  these  representatives  of  the  two  Departments  were  to  be  associated  to- 
gether in  one  center  it  would  insure  not  only  the  cooperation  of  the  two 
Departments,  but  would  also  make  certain  that  no  conditions  which  would 
contribute  to  the  health  of  the  community  would  remain  unknown  because 
of  a  lack  of  definition  of  duties  which  should  be  performed  by  the  two  De- 
partments. 

The  proposed  Health  Center  is  designed  as  an  experiment  to  enable  the 
City  to  determine  whether  or  not :  (a)  it  should  attempt  to  give  home  treat- 
ment; (b)  cases  can  be  classified  as  those  which  should  or  should  not  go 
into  hospitals  for  treatment;  (c)  information  as  to  living  and  working  con- 
ditions will  aid  in  the  prevention  and  treatment  of  sickness. 

A  Health  Center  properly  operated  should  accompHsh  the  following 
results : 

1.  It  would  bring  the  hospitals  and  Health  Department  into  coopera- 

tion, and  leave  no  uncovered  territory  between  the  functions  per- 
formed by  each. 

2.  It  would  enable  the  hospitals  to  secure  thorough  knowledge  of  the 

working  and  home  conditions  of  patients  coming  into  the  hospitals, 
and  any  factors  contributing  to  sickness. 

3.  It  would  retain  at  home  many  patients  that  otherwise  would  go  to 

the  hospitals,  and  would  exercise  an  intelligent  opinion  as  to  those 
that  should  or  should  not  be  treated  in  the  hospitals. 

4.  It  would  give  more  intelligent  care  to  convalescing  patients,  which  is 

now  given  in  but  a  limited  degree  by  the  Social  Service  Depart- 
ment of  Bellevue  Hospital,  and  would  restore  these  patients  to 
health  and  working  vigor  much  sooner  than  is  now  done. 

5.  It  would  advise  patients  when  to  go  to  an  out-patient  department, 

and,  by  visits  to  their  homes,  would  induce  them  to  make  as  many 
subsequent  visits  as  might  be  needed  to  effect  a  cure. 

6.  By  maintaining   supervision   over   contagious   and   infectious   cases 

cared  for  at  home,  their  possible  spreading  would  be  minimized. 

7.  Cases  of  contagion  discovered  by  the  physicians  and  nurses  of  Belle- 

vue would  come  to  the  notice  of  the  Inspectors  of  the  Health  De- 
partment at  once  and  thus  would  be  obviated  the  delay  due  to  the 
process  of  notification  by  mail. 

8.  The   instruction  of  mothers  in  a  Health  Center  should  be  a  ma- 

terial aid  in  securing  and  maintaining  health  conditions  in  the 
family. 
g.  Centralizing  information  and  records  of  a  district  at  one  place  would 
make  them  accessible  to  all  agents  in  the  district,  thus  rendering  it 
possible  to  treat  a  large  proportion  of  sickness  at  its  inception.  By 
this  system,  duplication  of  effort  would  be  reduced,  the  hospitals 
would  be  relieved,  and  the  amount  and  duration  of  sickness  di- 
minished. 

Work  and  Organization  of  the  Health  Center 

It  is  proposed  that  the  City  perform  an  experiment  by  establishing  and 
maintaining  one  Health  Center  for  a  sufficient  period  to  determine  whether 
or  not  the  work  performed  by  it  would  meet  a  social  need,  and  should  or 
should  not  be  enlarged  and  extended.  The  location,  character  of  plant, 
method  of  operation,  and  estimated  cost  of  maintenance  may  be  described  as 
follows : 


538  HOSPITAL   COMMITTEE 

Location 

The  Health  Center  should  be  located  in  the  Bellevue  ambulance  district, 
in  order  that  the  portion  of  its  work  assigned  to  the  Bellevue  Department 
may  be  supervised  by  the  officers  of  Bellevue,  and  also  that  the  patients  hav- 
ing been  discharged  from  Bellevue  Hospital  and  those  in  attendance  at  the 
Bellevue  Out-Patient  Department  and  residing  within  the  Bellevue  district 
may  be  assigned  to  the  physicians  and  nurses  of  the  Health  Center  for  after- 
care. The  building  should  be  selected  by  the  Health  Department,  since  the 
major  portion  of  its  space  would  be  occupied  by  the  work  of  this  Depart- 
ment. 

Functions  to  be  Performed 

1.  All  of  the  functions  now  performed  by  the  different  bureaus  of  the 
Health  Department  as  pertaining  to  this  district  should  be  centralized  in  this 
building.    The  functions  as  at  present  performed  consist  of : 

(a)  A  tuberculosis  clinic. 

(b)  A  child  hygiene  clinic,  having  associated  with  it  a  milk  depot. 

(c)  A  dental  clinic  for  children. 

(d)  Inspectors    of    contagious    and    infectious    diseases,    and    visiting 

nurses  associated  in  that  work. 

(e)  Inspectors  and  nurses  in  charge  of  the  inspection  of  school  children 

for  the  purpose  of  detecting  infectious  or  contagious  diseases. 

(f)  The  supervision  of  midwives. 

The  work  now  carried  on  by  the  different  bureaus  of  the  Health  Depart- 
ment as  outlined  above,  but  at  present  in  separate  centers,  could  be  similarly 
performed  when  associated  together  in  one  Health  Center. 

2.  Bellevue  Hospital  would  assign  to  this  Health  Center  i  graduate  in- 
terne, 2  trained  social  service  nurses,  and  4  nurse-attendants.  Patients  re- 
siding in  this  district,  discharged  from  Bellevue  and  needing  after-care,  and 
patients  attending  the  Out-Patient  Department  of  Bellevue  would  be  re- 
ferred to  these  agents  of  Bellevue,  who  would  visit  them  in  their  homes 
with  the  object  of  seeing  that  they  received  the  proper  after-care,  or  that 
they  carried  out  the  instructions  of  the  physicians  of  the  Out-Patient  De- 
partment, both  in  home  treatment  and  by  returning  at  stated  intervals  to 
the  Out-Patient  Department  for  subsequent  treatment.  In  performing  this 
work  many  new  cases  would  come  to  the  attention  of  these  physicians  and 
social  service  nurses,  and  decisions  would  be  rendered  as  to  whether  or  not 
they  should  receive  care  on  the  part  of  the  City,  and  whether  this  care 
should  be  given  at  home  or  in  Bellevue  Hospital,  according  to  the  character 
of  the  sickness  and  the  condition  of  the  home. 

In  the  beginning  it  would  not  seem  advisable  to  have  any  of  the  patients 
visit  the  Health  Center  for  treatment,  but  all  treatment  should  be  adminis- 
tered in  the  homes  of  the  patients.  After  the  Health  Center  had  been  oper- 
ated for  some  time  it  might  seem  to  be  advisable  to  have  certain  classes  of 
the  patients  come  to  the  Health  Center  for  continuation  of  treatment  initi- 
ated at  Bellevue.  Such  treatment  might  consist  of  redressing  wounds, 
spraying  and  cleansing  of  throat,  nose,  ears,  and  eyes,  and  such  other  con- 
tinuation treatment  that  may  be  of  a  simple  nature  and  practical  to  admin- 
ister with  few  appliances. 

3.  At  this  Health  Center  would  be  located  all  of  the  records  pertaining 
to  the  district  in  which  it  is  located,  and  these  centralized  records,  which 
would  contain  information  both  of  a  medical  and  social  nature,  would  be 


SICKNESS  IN   THE   HOME  539 

consulted  by  workers  of  the  Health  Center,  whether  from  the  Department 
of  Health  or  from  Bellevue.  By  thus  centralizing  information,  a  worker 
in  any  bureau,  or  from  other  departments  or  social  agencies,  would  at  once 
know  whether  or  not  there  had  been  sickness  in  the  home  of  the  family 
which  they  were  planning  to  visit,  the  nature  of  such  sickness,  the  character 
of  the  home,  and  such  other  information  as  would  throw  light  upon  the 
factors  which  in  the  past  contributed  toward  sickness. 

Assignment  of  Cases 

After  the  Health  Center  has  been  established  for  some  time,  and  some 
of  its  problems  simplified,  it  may  be  found  advisable  and  feasible  to  assign 
nurses  to  sub-districts,  or,  at  least,  to  families,  and  have  them  be  responsible 
for  all  of  the  sickness  in  such  sub-districts  or  in  connection  with  such  fam- 
ilies. At  the  present  time  it  not  infrequently  happens  that  nurses  from 
several  different  bureaus  or  from  bureaus  of  the  Health  Department  and 
from  Bellevue  visit  different  members  of  the  same  family,  thus  duplicating 
work.  This  duplication  of  effort  could  be  obviated  by  the  centralization  of 
bureaus  and  records. 

Control  of  the  Plant 

Inasmuch  as  the  Health  Department  would  occupy  the  larger  part  of 
the  proposed  plant  and  perform  most  of  the  functions,  it  would  seem  ad- 
visable to  place  the  control  and  operation  of  the  physical  plant  in  charge  of 
the  Health  Department,  and  such  space,  of  course,  as  might  be  needed  for 
the  work  of  Bellevue  Hospital  would  be  set  aside  for  its  purpose. 

Cost  of  Operating  the  Various  Functions 

All  of  the  functions  of  the  proposed  Health  Center  to  be  assigned  to 
the  Health  Department  are  at  present  performed  by  that  Department,  and 
the  expense  of  centralizing  their  execution  in  such  a  plant  would  not  ma- 
terially increase  their  individual  or  aggregate  expense. 

The  work  to  be  carried  on  by  Bellevue  would  require  i  graduate  interne, 
at  an  estimated  salary  of  $900;  2  trained  social  service  nurses  and  4  nurse- 
attendants,  at  an  estimated  expense  of  $1,200  for  nurses  and  $2,400  for  the 
nurse-attendants . 

A  large  element  of  value  of  such  a  Health  Center  would  be  the  central- 
ized records,  to  be  consulted  by  the  various  workers  of  both  departments. 
To  maintain  these  records  would  require  i  copyist,  for  additional  work  not 
now  done,  at  an  estimated  cost  of  $720. 

A  recapitulation  of  the  above  estimate  is  as  follows : 

1  physician  (with  maintenance  at  Bellevue) ....    $goo.oo 

2  trained  social  service  nurses  (with  maintenance 

at  Bellevue)   1,200.00 

4  nurse-attendants  (no  maintenance) 2,400.00 

I  copyist  (no  maintenance) 720.00 

Proportion  of  rent  to  be  paid  by  Bellevue 600.00 

$5,820.00 


540  HOSPITAL   COMMITTEE 

Possible  Economies  Resulting  from  its  Operation 

It  is  impossible  to  estimate  the  saving  in  dollars  and  cents  to  the  De- 
partments of  Bellevue  and  Health  which  would  result  from  the  installation 
and  operation  of  such  a  Health  Center.  Undoubtedly  it  would  permit  Belle- 
vue to  discharge  some  patients  somewhat  earlier  than  at  present,  although 
little  gain  may  be  expected  from  this  source,  inasmuch  as  the  Hospital  at 
the  present  time  is  discharging  patients  much  earlier  than  advisable.  Our 
municipal  hospitals  as  at  present  operated  do  not  care  for  a  patient  until 
restored  to  strength  and  able  to  work,  but  only  during  the  acute  stage  of 
his  sickness.  If  the  City  should  care  for  patients  until  able  to  work,  either 
their  stay  in  hospitals  would  be  longer  than  at  present,  or  it  would  be  neces- 
sary to  care  for  them  in  their  own  homes  or  in  convalescent  homes.  Such 
a  system  of  district  nursing  and  attending  physicians  as  provided  by  the 
Health  Center  could  care  for  these  patients  in  their  homes,  and  shorten  their 
period  of  sickness  and  absence  from  work.  The  City  by  this  system  might 
not  directly  secure  economy  in  operation,  but  at  least  would  perform  more 
fully  and  satisfactorily  a  function  which  it  has  assumed. 

A  direct  saving  would  be  secured  by  caring  for  a  certain  proportion  of 
patients  in  their  homes  that  otherwise  would  be  sent  to  the  hospitals  and 
there  maintained.  The  number  that  could  thus  be  cared  for  at  home  is 
entirely  problematical,  although  during  1912  nearly  4,000  of  the  admis- 
sions to  Bellevue  were  readmissions,  and  it  is  fair  to  assume  that  quite 
a  proportion  of  such  readmissions  could  have  been  cared  for  at  home 
by  district  nurses.  This  care  of  patients  at  home  would  not  only  save  the 
hospitals  the  cost  of  maintaining  these  patients,  but  also  the  cost  of  admit- 
ting and  discharging  them.  The  cost  of  maintaining  a  patient  in  the  Hos- 
pital is,  including  carrying  charges,  about  $2.50  per  day,  and  an  average  stay 
is  about  12  days,  so  that  each  patient  cared  for  at  home  instead  of  in  the 
Hospital  would  be  a  material  saving.  The  process  of  admitting  a  patient  to 
Bellevue  Hospital  requires  the  co-operation  of  at  least  19  persons,  using  in 
the  aggregate  about  2  hours  and  30  minutes.  The  process  of  discharge  occu- 
pies about  II  persons,  and  uses  in  the  aggregate  about  40  minutes.  This 
time,  estimated  at  the  rate  of  $3  per  day,  costs  Bellevue  somewhat  over  one 
dollar  for  the  process  of  admitting  and  discharging  a  patient.  It  is  very 
probable,  therefore,  that  a  large  portion  of  sickness  could  be  cared  for 
through  the  means  of  Health  Centers  and  home  visiting  more  economically 
than  in  our  hospitals,  which  are  very  expensive  to  build  and  to  operate. 

The  Health  Center  and  Local  Physicians 

It  may  be  argued  that  the  assignment  of  district  physicians  to  render 
service?  free  in  the  homes  would,  to  a  certain  extent,  interfere  with  the 
practice  of  private  physicians,  and  therefore  arouse  their  opposition.  This 
argument  may  be  met  by  the  statement  that  district  physicians  employed  by 
a  city  are  not  an  innovation ;  that  for  many  years  they  have  been  ernployed 
by  some  cities  and  are  recognized  as  performing  a  part  of  the  functions  of 
the  hospitals.  Complaint  has  been  made  in  some  cities  where  district  physi- 
cians are  employed  that  they  take  advantage  of  their  position  and  charge 
poor  people  fees,  when  they  are  supposed  to  render  their _  services  gratui- 
tously. This  charge  is  undoubtedly  well  founded  in  certain  instances,  but 
this  complaint  is  possibly  largely  due  to  the  fact  that  the  physician  is  allowed 
to  carry  on  private  practice  and  also  to  express  the  opinion  as  to  whether  or 
not  a  family  is  able  to  pay.  Under  the  system  proposed  for  New  York  the 
physicians  would  not  practice,  and  the  opinion  as  to  the  financial  condition 
of  the  family  would  be  expressed  by  the  visiting  social  service  nurse,  who 


SICKNESS  IN   THE  HOME 


541 


would  inquire  into  the  circumstances  of  the  family.  This  would  eliminate, 
in  a  large  degree,  the  objections  found  in  other  cities.  Under  these  circum- 
stances, private  physicians  would  have  little  ground  for  legitimate  complaint. 

General  Statement 

In  considering  the  foregoing  proposed  Health  Center  it  should  be  borne 
in  mind  that  nearly  90  per  cent,  of  sickness  takes  place  in  the  homes  rather 
than  in  hospitals.  Sickness  in  families  of  the  middle  and  upper  classes  is 
adequately  cared  for  by  private  physicians,  but  sickness  in  the  homes  of  the 
working  class  and  the  poor  is  inadequately  cared  for,  owing  to  the  lack  of 
funds  with  which  to  secure  medical  attendance  or  nursing  help.  It  follows 
then  that  but  two  classes  are  well  cared  for  when  sick;  namely,  the  well- 
to-do,  who  can  afford  the  best  of  nursing  at  home,  and  such  of  the  poor  as 
go  to  hospitals.  However,  the  amount  of  sickness  cared  for  by  these  two 
methods  is  a  small  proportion  of  the  total  sickness  in  the  community. 

In  the  early  history  of  our  country,  when  communities  were  smalll,  there 
were  neighborhood  mothers  who  rendered,  for  love  of  the  service,  nursing 
service  to  any  who  were  sick  and  in  need  of  their  help.  In  the  development 
from  small  communities  to  large  cities,  the  neighborhood  mother  has  ceased 
to  render  nursing  service,  and  no  one  has  taken  her  place,  except  the  trained 
nurse,  who  must  receive  more  for  her  services  than  the  laboring  man  or  a 
poor  person  can  afford  to  pay.  As  a  result  of  the  development  of  the  large 
cities  and  the  concurrent  loss  of  the  neighborhood  mothers  a  great  propor- 
tion of  the  population  is  without  adequate  care  in  time  of  sickness. 

The  hospital  can  never  be  an  adequate  substitute  for  the  home,  for  the 
largest  proportion  of  sickness  has  been  and  will  continue  to  be  cared  for  in 
the  latter.  If  a  municipality  assumes  the  obligation  to  adequately  care  for 
sickness  and  to  prevent  it  when  possible,  measures  must  be  taken  to  render 
service  in  the  home.  It  is  idle  to  argue  that,  if  a  city  provides  hospitals, 
the  people,  when  sick,  should  go  to  those  hospitals.  There  are  many  circum- 
stances under  which  a  sick  member  of  a  family  cannot  leave  home.  A 
widow  with  several  children  cannot  leave  her  children  uncared  for  while  she 
is  sent  to  and  remains  in  a  hospital.  Her  anxious  care  for  their  welfare 
would  militate  against  recovery  were  she  in  a  hospital;  while,  on  the  other 
hand,  should  she  be  nursed  in  her  home,  with  her  children  about  her  and 
well  cared  for,  the  relief  from  anxiety  would  lessen  the  strain  of  sickness 
and  hasten  recovery. 

At  the  present  time  a  municipal  hospital  is  unable  to  select  the  patients 
that  should  and  do  come  to  its  door.  Not  infrequently  those  most  in  need  of 
the  care  and  attention  that  a  hospital  can  give  remain  at  home,  and  those 
who  could  be  well  cared  for  at  home  go  to  the  hospitals.  This  condition 
cannot  be  corrected  so  long  as  hospitals  do  not  extend  their  work  beyond 
their  own  doors.  If  the  City  is  to  care  for  patients  at  great  cost  it  should 
have  some  means  of  knowing  whether  or  not  it  is  caring  for  the  cases  that 
are  most  in  need  of  its  help.  At  the  present  time  the  City  has  no  such 
knowledge  nor  means  of  securing  it. 

The  City  is  proposing  to  expend  fully  $10,000,000  in  a  new  Bellevue 
Hospital.  This  will  be  one  of  the  best  equipped  hospitals  in  the  world. 
How  are  its  facilities  to  be  used  to  accomplish  the  best  results  ?  Who  are  to 
occupy  its  beds?  Will  the  aggregate  amount  of  sickness  be  diminished  be- 
cause Bellevue  exists?  It  would  seem  to  be  the  part  of  wisdom  for  the 
City  to  inquire  whether  or  not  it  could  care  for  more  sickness  for  less  money 
by  caring  for  a  portion  of  it  in  the  homes,  and  by  reserving  its  expensive 
hospitals  for  the  care  and  treatment  of  those  cases  only  which  need  special 
equipment  and  attention  that  cannot  be  supplied  in  the  homes. 


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SICKNESS  IN   THE   HOME 


543 


DIAGRAM  I. 
Location  of  House-to-House  Investigation  in  a  Lower  East  Side  District. 


St(9tr\ton.      St. 


RiVif^gtorx       St. 


544 


HOSPITAL   COMMITTEE 


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SICKNESS  IN  THE  HOME 


545 


DIAGRAM  II. 
Location  of  House-to-House  Investigation  in  a  West  Side  District. 


J      L 


lOtK  Ave. 


9tK   Ave. 


8  th  Av^. 

D 


7tK  Ave. 
1     I '     I \    f" 


Section  VIIL— HOSPITAL    EMPLOYEES 

1.  Hospital    Helpers 

2.  Proposed     Salary     and    Wage     Schedule    for     the 

Department  of  Public  Charities 


I.    HOSPITAL   HELPERS 


THE  INVESTIGATION 

The  Problem 

The  menial  work,  some  portion  of  the  clerical  work,  and  a  portion  of  the 
attendant  service  in  the  wards  in  the  municipal  hospitals  in  New  York 
City  are  performed  by  persons  officially  classified  as  Hospital  Helpers. 
They  are,  especially  in  the  lower  grades,  chiefly  recruited  from  the  ranks 
of  the  "down  and  outs"  and  the  "periodic  drunks."  The  pay  of  these 
Hospital  Helpers  ranges  from  $60  to  $720  per  year.  Between  and  including 
these  minimum  and  maximum  rates  are  21  grades.  It  has  been  the  gen- 
eral custom  of  the  Board  of  Estimate  and  Apportionment  to  appro- 
priate the  amount  required  for  these  Helpers  in  blanket  amounts  for  the 
respective  departments.  In  the  Budget  for  19 12,  for  the  Department  of 
Bellevue  and  Allied  Hospitals,  a  specific  amount  was  appropriated  in  each 
grade  for  a  specified  number  of  Helpers.  For  the  Department  of  Charities, 
a  blanket  amount  was  provided.  It  has  been  repeatedly  stated  by  Commis- 
sioners of  Charities  and  by  the  superintendents  of  municipal  institutions 
that  this  class  of  help  has  been,  and  is,  very  unreliable,  resulting  in  fre- 
quent changes  in  personnel.  In  the  1909  Annual  Report  of  the  Depart- 
ment of  Public  Charities,  Commissioner  Robert  W.  Hebberd  made  the  fol- 
lowing statement  in  regard  to  Hospital  Helpers: 

The  principal  general  needs  of  the  Department,  briefly  stated,  are,  a  better  class 
of  Helpers  in  the  lower  grades,  and  a  more  rapid  extension  of  the  facilities  for  the 
care  of  patients  and  inmates  of  the  institutions. 

Better  Helpers  can  only  be  secured  through  an  increase  in  the  budget  allow- 
ance for  the  wages  of  such  Helpers,  as  well  as  the  exercise  of  greater  care  in  their 
selection,  which  would  then  be  practicable. 

The  Commissioners  of  the  State  Board  of  Charities  representing  New 
York  City,  in  a  report  dated  July  10,  191 1,  on  the  "Department  of  Public 
Charities  of  the  City  of  New  York,"  made  the  following  statement  with 
regard  to  the  employees  of  the  municipal  hospitals: 

The  problem  of  getting  and  keeping  competent  employees  is  apparently  as  far 
as  ever  from  solution,  while  the  actual  situation  is  more  trying  than  ever.  The 
necessary  nurses  for  the  new  neurological  hospital  at  the  City  Home,  Blackwell's 
Island,  were  secured  only  by  sacrificing  by  transfer  the  salary  designed  for  the 
Deputy  Medical  Superintendent  at  the  Randall's  Island  institution.  Such  make- 
shifts are  often  necessary  to  provide  sufficient  help  to  keep  the  work  of  the  Depart- 
ment going.  Perhaps  more  serious  is  the  matter  of  the  low  wages  allowed  to 
employees  in  the  lower  grades.  It  is  officially  announced  (October,  1910)  that,  of 
2,361  employees,  1,208  are  paid  at  the  rate  of  less  than  $240  per  year.  Of  these, 
1,050  are  rated  at  $150  or  less  per  year.  In  this  part  of  the  working  force  there 
are  above  6,000  changes  during  each  year,  an  average  of  about  5  in  each  of  the 
positions  involved.  That  the  work  of  the  institutions  is  accomplished  at  all  with 
such  an  underpaid  and  unstable  corps  of  workers  is  remarkable;  that  persons  en- 
trusted with  duties  having  to  do  with  the  care  of  the  aged,  the  sick,  and  the  help- 
less are  expected  to  work  for  such  wages  is  a  disgrace  to  the  City. 

It  has  been,  and  is,  the  opinion  of  officers  of  the  institutions  that  if 
the  pay  of  this  class  of  employees  were  raised  more  reliable  help  could,  and 

551 


552  HOSPITAL   COMMITTEE 

would,  be  secured,  resulting  in  a  less  frequent  change  in  personnel  and 
more  reliable  service.  Repeated  recommendations  to  this  end  have  been 
made  to  the  Board  of  Estimate  and  Apportionment,  and  from  time  to  time 
additional  funds  have  been  appropriated,  resulting  in  a  somewhat  increased 
pay  from  year  to  year.  The  minimum  pay  in  Bellevue  at  present  is  $i8o 
per  year.  In  1908,  City  Hospital,  Metropolitan  Hospital,  New  York  City 
Home  (Blackwell's  Island),  and  Kings  County  Hospital  combined  had  an 
average  of  ^y  employees  receiving  less  than  $120  per  year.  In  191 1  but 
one  of  these  four  institutions,  namely,  City  Home,  had  retained  any  em- 
ployees below  the  grade  of  $120,  and  this  institution  had  2,  i  at  $60,  and 
another  at  $90.  In  other  words,  between  1908  and  191 1  the  grades  below 
$120  had  been  dropped  and  the  average  pay  had  been  increased. 

An  endeavor  has  been  made  to  ascertain  what  the  effect  of  the  gradual 
increase  in  the  amount  of  pay  has  been  on  the  average  length  of  service  of 
these  employees,  and  also  to  ascertain  what  the  relative  length  of  stay  has 
been  in  the  grades   receiving  different  amounts   of  pay. 

Scope  and  Method  of  Inquiry 

To  secure  data  which  would  represent  average  conditions  and  tendencies 
the  records  of  the  Departments  were  consulted  covering  a  period  of  4 
years,  beginning  January  i,  1908,  and  ending  December  31,  191 1.  These 
records  were  taken  from  the  Civil  List  of  the  City  Record  published  semi- 
annually, January  i  and  July  i  of  each  year,  which  list  gave  the  name  of 
each  employee,  his  classification,  date  of  entry  into  the  service,  date  of  dis- 
charge, and  any  increase  or  decrease  in  salary.  All  employees  having  left 
the  service  during  the  4  years  were  summarized  under  the  grades  in  which 
they  served  at  the  time  of  leaving  the  service.  The  number  serving  in 
each  grade  was  ascertained  by  counting  those  remaining  upon  the  roll  at 
a  given  date ;  and  these  figures  were  checked  with  the  payrolls  of  the  institu- 
tions. The  summary  taken  from  the  City  Record  did  not  in  all  cases  cor- 
respond with  the  report  made  by  the  institutions.  Where  the  institutions 
made  report  their  figures  were  accepted  rather  than  the  count  taken  from 
the  City  Record.  This  method  of  tabulation  has  made  it  possible  to  ascer- 
tain the  total  number  employed  in  each  grade  as  of  a  given  date ;  the  total 
number  having  left  the  service  during  a  given  period;  the  percentage  of 
changes  based  upon  the  number  in  the  grade;  and  a  comparison  of  the 
percentages  of  changes  in  the  different  grades.  By  covering  a  period  of 
4  years  the  effect  on  the  length  of  stay  of  raising  the  pay  could  be  more 
readily  noted. 

Results 

In  summarizing  the  results  of  the  tabulations  in  the  Department  of 
Charities  the  following  institutions  have  entered  into  the  computations :  City 
Hospital,  including  training  school;  Metropolitan  Hospital,  including  train- 
ing school ;  City  Home,  Blackwell's  Island ;  Children's  Schools  and  Hos- 
pitals ;  Kings  County  Hospital,  including  training  school ;  Cumberland 
Street  Hospital ;  Coney  Island  Hospital ;  and  Farm  Colony.  There  are 
omitted  from  the  list  as  summarized,  the  administrative  department,  the 
Bureaus,  and  the  Municipal  Lodging  House.  In  the  Department  of  Belle- 
vue and  Allied  Hospitals  all  of  the  Hospitals  are  included.  In  the  Health 
Department  no  Hospital   Helpers  are   employed,   but   for  the  purpose  of 


HOSPITAL   HELPERS  553 

comparison  all  domestics,  laborers,  and  orderlies  were  tabulated  as  cor- 
responding in  the  main  to  the  Hospital  Helpers  in  the  other  two  Depart- 
ments. 

The  term  "discharges"  as  used  in  this  report  includes  all  those  having 
left  the  service  either  voluntarily  or  by  dismissal. 

Comparison  by  Years 
Percentage  of  Discharges 

The  institutions  in  the  Department  of  Charities  during  the  year  1908  em- 
ployed, on  an  average,  859  Hospital  Helpers  in  the  9  lowest  grades, 
from  $60  to  $180  per  year.  In  191 1  in  the  same  grades  the  institutions 
employed  990.  During  these  4  years  the  institutions  had  practically 
eliminated  the  4  lowest  grades,  leaving  in  those  grades  but  3  employees, 
2  at  $60  and  i  at  $96.  In  other  words,  the  38  positions  in  the  4  lowest 
grades  in  1908  were  dropped.  In  1908  the  $150  grade  contained  259  and 
the  $180  grade  yy.  In  191 1  the  $150  grade  contained  358  and  the  $180 
grade  312.  The  promotions  from  the  lower  grades  to  the  higher,  and  also 
the  increases  in  the  number  in  the  higher  grades,  did  not  materially  change 
the  percentage  of  discharges  in  the  9  grades.  The  number  of  discharges 
in  these  9  grades  during  the  year  1908  equaled  259  per  cent,  of  those 
employed  in  these  grades.  During  the  year  191 1  the  discharges  were  261 
per  cent.,  which  is  slightly  higher  than  the  percentage  of  discharges  in  the 
earlier  year,  which  fact  seems  to  indicate  that  the  dropping  of  the  lower 
grades  and  the  increasing  of  the  number  in  the  higher  grades  did  not 
reduce  the  percentage  of  discharges. 

The  Department  of  Bellevue  and  Allied  Hospitals  had  no  Hospital  Help- 
ers in  grades  under  $180  per  year  during  the  4  years,  1908-11.  How- 
ever, in  the  4  grades,  $180,  $192,  $216,  and  $240,  this  Department 
employed  in  1908  423  Hospital  Helpers,  and  in  the  corresponding  grades 
in  191 1  it  employed  496.  The  number  of  Helpers  in  the  $180  grade 
was  reduced  from  172  to  158;  in  the  $192  grade  the  number  was  in- 
creased from  I  to  10;  in  the  $216  grade  the  number  was  increased  from 
I  to  7;  and  in  the  $240  grade  from  249  to  321,  showing  that  there  had  been 
a  gradual  promotion  from  the  $180  to  the  $240  grade ;  moreover,  73  Helpers 
were  added,  largely  to  the  $240  grade.  These  promotions  and  additions 
to  the  higher  grade,  however,  did  not  reduce  the  percentage  of  discharges 
during  that  period.  In  1908  the  discharges  were  334  per  cent,  of  the 
number  employed  in  the  4  grades.  In  191 1  the  discharges  were  401  per 
cent,  of  those  employed  in  these  grades.  In  the  $180  grade  the  per- 
centage of  discharges  increased  from  422  per  cent,  in  1908  to  515  per  cent, 
in  191 1.  Although  the  number  in  the  $240  grade  had  been  increased 
by  72  the  percentage  of  discharges  in  that  grade  was  not  decreased,  but, 
on  the  contrary,  was  increased  from  273  per  cent,  in  1908  to  351  per  cent,  in 
,1911. 

Average  Length  of  Stay  of  Those  Leaving  the  Service 

In  the  Department  of  Charities  the  average  length  of  stay  of  Helpers 
during  the  years  1908-09  employed  in  all  grades  including  $360  and  below 
was  134  days.  In  1910-11  the  average  length  of  stay  for  the  same  grades 
was  133  days.  In  1908-09  there  was  an  average  of  526  employees  in  the 
grade  of  $144  and  below,  and  in  the  period  of  1910-11  this  number  had  been 


554  HOSPITAL   COMMITTEE 

reduced  to  374.  The  number  taken  from  these  lower  grades  was  added 
to  the  higher  grades.  In  1908-09  there  were  but  712  in  the  grades  ranging 
from  $150  to  $360,  and  in  191 1  there  were  1,020  in  these  grades.  Since 
the  average  length  of  stay  was  134  days  in  1908  and  but  133  days  in 
191 1,  it  will  be  noticed  that  the  shifting  from  the  lower  grades  to  the 
higher  grades  in  these  years  under  consideration  actually  reduced  the 
average  length  of  stay  by  i  day. 

In  the  Department  of  Bellevue  and  Allied  Hospitals,  the  average  length 
of  stay  of  Helpers  during  the  years  1908-09  in  the  grades  from  $180  to 
$360  was  90  days.  In  1910-11  the  average  length  of  stay  for  the  corre- 
sponding grades  was  yy  days.  Within  these  4  years  the  number  of  em- 
ployees in  these  grades  had  materially  increased.  In  1908-09  in  the  grades 
from  $180  to  $216  there  were  170  helpers.  In  1910-11  this  number  was 
decreased  by  5.  On  the  other  hand,  the  grades  from  $240  to  $360  in 
1908-09  had  330,  and  in  1910-11  these  grades  had  been  increased  to  405. 
This  marked  increase  in  the  number  in  the  upper  grades  not  only  did  not 
increase  the  average  length  of  stay,  but  actually  reduced  it  by  an  average 
of  13  days. 

Comparison  by  Grades 

A  comparison  by  grades  will  throw  light  upon  the  Hospital  Helper  prob- 
lem from  another  angle.  In  the  following  comparison  the  number  of  dis- 
charges per  year  in  a  particular  grade  is  figured  as  the  percentage  of  the 
average  number  in  that  grade  for  the  year.  For  instance,  if  there  were 
50  in  a  grade  and  100  left  the  service,  these  discharges  would  represent 
200  per  cent,  of  the  number  in  the  grade. 

By  191 1,  in  the  Department  of  Charities,  the  $60,  $72,  $90,  and  $96 
grades  had  practically  been  abolished.  In  order  to  ascertain  the  effect  of 
these  grades,  when  existent,  upon  the  length  of  stay,  it  was  necessary  to  go 
back  at  least  i  year.  The  year  1909  is  probably  more  representative  of  the 
conditions  existing  before  these  grades  were  abolished.  In  that  year,  1909, 
there  were  241  per  cent,  of  discharges  in  grade  $60;  250  per  cent,  in 
grade  $72;  183  per  cent,  in  grade  $90;  241  per  cent,  in  grade  $120;  255 
per  cent,  in  grade  $144;  and  280  per  cent,  in  grade  $150.  These  propor- 
tions very  closely  prevailed  in  the  year  1910.  It  will  be  noticed  that  the 
percentages  of  changes  were  fully  as  high,  and,  in  fact,  somewhat  higher, 
in  grades  $144  and  $150  than  in  the  lower  grades,  indicating  that  the  larger 
amounts  received  by  the  Helpers  in  these  grades  did  not  reduce  the  per- 
centage of  discharges  from  the  service. 

In  no  grade  below  $180  was  there  a  perceptible  reduction  in  the  per- 
centage of  discharges.  In  this  grade,  in  1909,  there  was  124  per  cent,  of 
discharges  and  in  191 1  118  per  cent.  Here  it  will  be  noticed  that  the 
compensation  of  $180  apparently  reduced  the  number  of  changes  somewhat 
more  than  half.  While  the  $180  grade  in  1909  showed  124  per  cent,  of 
discharges,  the  $240  grade  in  the  same  year  showed  202  per  cent.  In 
191 1  the  $180  grade  had  118  per  cent,  of  discharges,  while  the  $240  grade 
had  149  per  cent.  This  difference  in  the  percentage  of  discharges  in  the 
grades  of  $180  and  $240  is  observable  in  each  of  the  4  years  1908, 
1909,  1910,  and  191 1.  In  no  grade  below  $300  were  the  percentages  of 
changes  less  than  in  the  $180  grade.  During  the  year  1909,  in  the  $300 
grade  the  discharges  were  109  per  cent;  in  1910  they  were  ill  per  cent.; 
and  in  191 1  92  per  cent.  These  percentages  gradually  decreased  in  the 
grades  above  $300. 


HOSPITAL   HELPERS  555 

As  stated,  the  $240  grade  in  each  of  the  institutions  showed  a  larger 
percentage  of  discharges  than  the  $180  grade.  Such  a  showing  was  so 
unexpected  that  an  effort  was  made  to  ascertain  the  cause  of  the  higher 
grade  showing  also  a  higher  percentage  of  discharges.  It  was  suggested 
by  some  of  the  officials  of  the  Department  of  Public  Charities  that  possibly 
the  fact  that  more  women  than  men  were  employed  in  the  $180  grade,  and 
that  the  women  were  more  constant  in  service  than  the  men,  would  tend  to 
make  the  percentage  of  discharges  in  the  $180  grade  less  than  in  the  $240 
grade,  which  is  composed  more  largely  of  men. 

The  number  of  discharges  of  males  and  females,  calculated  separately, 
was  determined  in  these  2  grades  as  applied  to  City,  Metropolitan,  and 
Kings  County  Hospitals.  In  these  institutions,  in  the  $180  grade  the 
males  showed  104  per  cent,  of  discharges,  as  compared  with  130  per  cent, 
for  the  females.  In  the  $240  grade  there  was  209  per  cent,  of  discharges 
among  the  males  and  139  per  cent,  among  the  females.  Inasmuch  as  the 
number  of  males  and  females  was  very  nearly  the  same  in  the  $180  grade, 
and  the  females  showed  a  higher  percentage  of  discharges  than  the  males, 
the  disparity  between  the  discharges  in  the  $180  grade  and  the  $240  grade 
as  observed  in  all  institutions  cannot  be  explained  by  the  fact  that  a  larger 
number  of  women  are  employed  in  the  $180  grade  and  the  assumption  of 
greater  constancy  of  service  on  the  part  of  the  women. 

It  is  probable  that  the  larger  percentage  of  discharges  in  the  $240  grade 
can  be  accounted  for  by  the  fact  that  the  class  of  men  in  this  grade  is 
composed  mostly  of  those  who  in  former  years  occupied  a  higher  position 
in  life  and  received  larger  remuneration,  while,  generally  speaking,  the  men 
employed  in  the  $180  grade  have  always  performed  menial  service  and  have 
not  received  materially  higher  compensation  than  they  at  present  receive, 
and,  therefore,  they  are  more  inclined  to  be  satisfied  with  the  pay  given 
them.  In  other  words,  the  $240  grade  is  more  largely  composed  of  men  who 
have  known  better  times  and  have  become  discouraged  and  despondent, 
and  little  inclined  to  render  continuous  service  in  any  position  that  offers 
small  compensation,  whereas  the  $180  men  are  serving  in  a  grade  which 
they  have  in  the  main  always  occupied  before  entering  the  hospital  service. 

It  seems  fair  to  draw  the  conclusion  that  no  grade  above  $60  secures  a 
longer  stay  than  maintains  in  that  grade  until  the  grade  of  $180  is  reached, 
and  the  increases  to  the  $192  and  $216  grades  do  not  secure  a  longer  tenure 
than  the  $180  grade. 

The  facts  noted  above  may  be  stated  in  another  form,  as  follows:  Of 
the  total  number  having  left  the  service  during  the  years  1908-09,  in  the 
$60  grade  75  per  cent,  stayed  less  than  3  months,  while  but  17  per  cent, 
stayed  more  than  6  months.  In  the  $90  grade  62  per  cent,  stayed  less 
than  3  months  and  13.8  per  cent,  stayed  over  6  months.  In  the  $120  grade 
68  per  cent,  stayed  less  than  3  months  and  15  per  cent,  more  than  6  months. 
In  the  $144  grade  71  per  cent,  stayed  less  than  3  months  and  12.8  per  cent, 
over  6  months.  In  the  $150  grade  68  per  cent,  stayed  less  than  3  months 
and  15  per  cent,  over  6  months.  It  will  be  noticed  that  the  percentages  in 
the  $150  grade  were  the  same  as  in  the  $120  grade,  and  that  the  $120  and 
$90  grades  did  not  differ  materially  from  the  $60  grade.  In  the  $180 
grade  these  percentages  were  reversed ;  50.9  per  cent,  stayed  less  than  3 
months,  while  27  per  cent,  stayed  over  6  months.  Again,  in  the  $240 
grade  it  will  be  noticed  that  the  results  were  less  favorable  than  in  the 
$180;  61.5  per  cent,  stayed  less  than  3  months  and  but  20  per  cent,  stayed 
over  6  months.    Not  until  the  $300  grade  was  reached  were  the  percentages 


556  HOSPITAL  COMMITTEE 

again  reversed.  In  this  grade  46  per  cent,  stayed  less  than  3  months  and 
36.4  per  cent,  stayed  over  6  months.  It  will  be  noticed  that  all  grades 
under  $180  seemed  to  have  practically  the  same  percentage  of  changes 
in  the  service. 

In  the  Department  of  Bellevue  and  Allied  Hospitals,  as  previously  stated, 
there  are  no  grades  under  $180.  In  the  $180  grade  the  percentages  of  dis- 
charges in  the  years  indicated  were  as  follows :  In  1908,  422  per  cent. ;  in 
1909,  501  per  cent.;  in  1910,  486  per  cent;  and  in  191 1,  515  per  cent. 
The  $240  grade  showed  somewhat  better  results,  as  follows :  In  1908, 
273  per  cent.;  in  1909,  315  per  cent.;  in  1910,  387  per  cent.;  and  in  1911, 
351   per  cent. 

The  $240  grade  in  Bellevue  and  Allied  Hospitals  likewise  showed  an 
improvement  over  the  $180  grade  when  comparing  the  relative  time  of 
stay  in  these  2  grades  for  the  years  1908-09.  In  the  $180  grade  81.5 
per  cent,  stayed  3  months  or  less,  while  but  7  per  cent,  stayed  over  6 
months.  In  the  $240  grade  71.5  per  cent,  stayed  3  months  or  less,  while 
12.6  per  cent,  stayed  over  6  months.  A  less  improvement  is  noted  in  the 
years  1910-11.  In  this  period,  in  the  $180  grade  83  per  cent,  stayed  3 
months  or  less  and  7  per  cent,  stayed  over  6  months,  while  in  the  $240 
grade  81  per  cent,  stayed  3  months  or  less  and  9  per  cent,  stayed  over  6 
months.  The  figures  seem  to  indicate  that  the  $216  grade  secured  some- 
what better  results  than  the  $240  grade ;  in  1908-09,  58  per  cent,  stayed  3 
months  or  less  in  the  former  grade  and  12.5  per  cent,  stayed  over  6 
months,  and  in  1910-11,  75  per  cent,  stayed  3  months  or  less  and  15  per 
cent,  stayed  over  6  months. 


Comparison  by  Departments 

A  comparison  of  the  Department  of  Public  Charities  with  Bellevue 
and  Allied  Hospitals  shows  some  results  of  interest. 

As  previously  stated,  Bellevue  and  Allied  Hospitals,  during  the  4  years 
covered  by  the  investigation  of  this  subject,  had  no  grades  imder  $180. 
In  that  grade,  however,  the  percentage  of  changes  during  the  year  1908  was 
422  per  cent.  The  average  percentage  of  changes  for  that  grade  and  also 
including  the  8  grades  below  it  in  the  Department  of  Public  Charities 
was  but  259  per  cent.  In  1909  the  percentage  of  changes  in  the  $180  grade 
in  Bellevue  and  Allied  Hospitals  was  501  per  cent.  In  the  9  lowest  grades 
in  the  Department  of  Public  Charities  during  the  year  1909  the  per- 
centage was  but  243  per  cent.  In  19 10  the  percentage  of  changes  in  the 
$180  grade  in  Bellevue  and  Allied  Hospitals  was  486  per  cent.,  and  in  the 
9  lowest  grades  in  the  Department  of  Public  Charities  it  was  260  per 
cent.  A  like  comparison  for  the  year  191 1  shows  515  per  cent,  for  Belle- 
vue and  Allied  Hospitals,  and  but  261  per  cent,  for  the  Department  of 
Public  Charities.  The  noteworthy  difference  between  these  percentages 
seems  to  indicate  very  clearly  that  in  the  9  lowest  grades  of  the  Depart- 
ment of  Public  Charities,  the  lowest  of  which  is  $60,  the  number  of  dis- 
charges is  materially  less  than  in  the  $180  grade  of  Bellevue  and  Allied 
Hospitals,  which  is  the  highest  of  the  9  lowest  grades  in  the  Depart- 
ment of  Public  Charities.  It  is  also  noteworthy  that  the  percentage  of 
changes  in  every  grade  from  $180  to  the  highest,  $720,  is  materially  lower 
in  the  Department  of  Public  Charities  than  in  Bellevue  and  Allied  Hos- 
pitals. 


HOSPITAL   HELPERS  557 

As  previously  stated,  the  average  length  of  stay  of  those  discharged 
by  Bellevue  and  Allied  Hospitals  during  the  years  1908-09  in  the  grades 
ranging  from  $180  to  $360  was  90  days,  and  in  the  same  grades  during 
the  years  1910-11,  yy  days.  In  the  Department  of  Public  Charities,  the 
average  length  of  stay  for  all  grades,  beginning  at  $60,  up  to  and  including 
$360,  during  the  years  1908-09  was  134  days.  In  the  same  grades  in 
1910-11  the  average  length  of  stay  was  133  days.  Thus,  it  will  be  noticed 
that  the  average  length  of  stay  in  the  Department  of  Public  Charities,  in- 
cluding 8  low  grades  not  existing  in  Bellevue  and  Allied  Hospitals, 
was  materially  higher  than  in  the  Bellevue  Department. 

A  similar  disparity  is  apparent  when  the  average  length  of  stay  of  those 
remaining  in  the  service  December  31,  191 1,  is  taken  into  consideration. 
Of  those  thus  remaining  in  the  service  in  Bellevue  and  Allied  Hospitals  23 
per  cent,  had  remained  over  6  months,  while  in  the  Department  of  Charities 
69  per  cent,  had  stayed  6  months  or  longer.  In  the  $240  grade  in  Bellevue 
and  Allied  Hospitals  41  per  cent,  had  remained  6  months  or  more,  while 
in  the  Department  of  Public  Charities  56  per  cent,  had  stayed  over  6 
months.  The  percentages  were  somewhat  more  favorable  to  Bellevue  in  the 
$300  and  $480  grades,  but  the  number  employed  in  these  grades  was  too 
small  to  give  a  basis  for  a  fair  comparison. 

Personnel  Involved  in  the  Dismissals  and  Resignations  in  the  Hospital 
Helper  Class 

An  endeavor  has  been  made  to  ascertain  the  number  of  different  indi- 
viduals involved  in  the  dismissals  and  resignations  in  the  Hospital  Helper 
class  in  the  Department  of  Public  Charities.  The  object  of  this  inquiry  was 
to  determine  to  what  extent  persons  at  work  had  previously  been  employed 
in  the  Department,  and  through  such  employment  had  gained  a  knowledge 
of  the  work  in  the  hospitals. 

In  the  office  of  the  Secretary  of  the  Department  is  kept  a  card  catalogue 
of  all  Hospital  Helpers  and  on  these  cards  are  Hsted  all  changes  in  a  posi- 
tion. This  record  would  give  full  data  as  to  the  number  of  different  indi- 
viduals employed  were  it  not  for  the  fact  that  it  is  quite  a  common  practice 
among  those  of  the  Hospital  Helper  class  to  reemploy  under  different 
names.  When  it  is  discovered  that  a  person  is  serving  under  a  name  not 
formerly  used  when  employed  in  the  Department  an  entry  is  made  on  the 
card  under  the  name  used  in  the  original  employment.  It  is  probable  that 
many  of  the  names  in  this  card  catalogue  list  are  aliases,  and  represent  not 
different,  but  the  same  individuals.  To  what  extent  this  may  be  true,  it  is 
impossible  to  determine. 

The  cards  representing  different  individuals  were  checked  by  employees 
of  the  Committee  and  the  total  number  of  dismissals  and  resignations  noted 
for  the  years  1908,  1909,  1910,  and  191 1.  During  these  4  years,  according 
to  the  annual  reports  of  the  Department,  there  were  15,649  dismissals  and 
resignations  in  all  the  institutions  of  the  Department.  The  Department 
also  states  in  its  reports  that  95  per  cent,  of  these  changes  were  among 
the  class  of  help  who  received  $20  and  less  per  month.  Since  few  Hospital 
Helpers  receive  more  than  this  amount,  the  statement  of  the  Department 
may,  with  reasonable  accuracy,  be  applied  to  the  Hospital  Helper  class  as 
a  whole.  Deducting  5  per  cent.,  there  were  14,867  dismissals  and  resigna- 
tions in  the  Hospital  Helper  class  during  the  4  years  in  the  grades 
below  $240.    During  this  same  period,  according  to  the  cards  in  the  Secre- 


5s8  HOSPITAL  COMMITTEE 

tary's  office,  8,467  different  individuals  had  left  the  Department  through 
resignation  or  dismissal.  In  other  words,  the  dismissals  and  resignations 
were  78  per  cent,  greater  tlian  the  number  of  persons  employed  as  Hospital 
Helpers.  It  is  altogether  probable  that  this  percentage  should  be  consider- 
ably higher,  owing  to  the  fact,  above  stated,  that  the  cards  seem  to  represent 
more  individuals  than  were  probably  employed. 

On  these  cards  also  is  recorded  all  changes  in  the  Department.  These 
changes,  as  listed  yearly  in  the  annual  reports,  are  "Appointments,  Pro- 
motions, Resignations,  Transfers,  Dismissals,  Reductions."  During  the  4 
years  stated,  according  to  the  annual  reports,  there  were  36,497  changes 
among  all  employees  of  the  Department.  This,  reduced  by  5  per  cent, 
makes  34,672  changes  occurring  among  Hospital  Helpers  in  the  grades 
below  $240.  According  to  the  cards  referred  to  above  there  were  9,987 
different  individuals  involved  in  these  changes  during  the  4  years.  In  other 
words,  the  changes  were  347  per  cent,  of  the  Hospital  Helpers  employed. 
This  indicates  that  in  quite  a  measure  the  same  individuals  are  involved 
in  the  total  number  of  changes  reported  from  year  to  year. 

Graphic  Presentation  of  the  Preceding  Data 

A  graphic  presentation  of  the  data  set  forth  in  the  preceding  pages  is 
contained  in  diagrams  Nos.  i,  2,  3,  and  4,  on  accompanying  pages. 

Diagram  No.  i  shows  the  percentage  of  those  employed  in  each  grade  in 
all  institutions  in  the  Department  of  Public  Charities  who  worked  3  months 
or  less ;  those  who  worked  from  3  to  6  months ;  and  those  who  remained 
more  than  6  months.  It  will  be  noted  that  in  the  grades  from  $60  to  $168 
the  percentage  of  discharges  of  those  having  served  less  than  3  months 
is  practically  the  same  for  each  grade.  The  $96  grade  shows  an  exception 
to  this  statement.  This  exception  is  probably  due  to  the  fact  that  very  few 
were  employed  in  this  grade.  Not  until  the  $180  grade  is  reached  is 
there  a  notable  improvement.  Of  the  grades  from  $180  to  $264,  inclusive, 
each  show  about  the  same  percentage  of  discharges,  all  being  materially 
less  than  the  preceding  group.  The  grades  beginning  at  $300  and  upward 
show  a  gradual  improvement  in  the  percentage  of  discharges  and  length  of 
stay.  This  diagram  makes  it  apparent  that  an  increase  of  pay  from  grade 
to  grade  from  $60  to  $168  does  not  decrease  the  percentage  of  discharges 
nor  increase  the  length  of  stay.  The  same  may  be  said  for  the  group  from 
$180  to  $264,  except  that  there  is  a  notable  improvement  in  the  conditions 
of  this  group  as  compared  with  the  former.  The  diagram  makes  it  very 
apparent  that  the  upper  grades,  beginning  with  $360,  are  much  more  con- 
stant in  service. 

Diagram  No.  2  shows  the  ratio  of  those  leaving  the  various  grades, 
to  the  number  of  positions  in  such  grades.  It  also  makes  a  comparison 
on  a  like  basis  between  the  Department  of  Charities  and  the  Department  of 
Bellevue  and  Allied  Hospitals.  It  will  be  noticed  by  referring  to  this  diagram 
that  the  conditions  in  1908  were  very  nearly  the  same  as  in  191 1.  Nearly 
the  same  percentages  are  shown  in  the  corresponding  groups  for  each 
period.  In  the  Department  of  Public  Charities  the  number  of  different  per- 
sons employed  in  Grades  $60  to  $168  was  782  in  1908  and  678  in  191 1, 
with  an  increase  in  pay  of  $5  per  year  in  these  grades  between  these 
periods.  In  grades  $180  to  $264  the  percentages  of  discharges  in  the  two 
periods  were  about  the  same,  although  the  number  employed  in  these  grades 


HOSPITAL   HELPERS 


559 


Diagram  1 
Depahtmeut  of  Public  Charities  All  Institutions 

Comparative  length  of  service  in  the  different  grades. 

COVERING    A     period     OF      FOUR    YEARS,         1908-1911 


Percental  o"f   to+aJ.   number  in  service  in  e&ch  g>-ad<? 


I  I      In  service    3  mon+ks  or  less 

t 'vVi^i'j      3  to  6  moniKs 
I  I      6  rnon+Ks  or  more 


This      diagTVaTu     sKows     •wha+    per  cen+    oi"    those    ernployed    in  cajch 
^rade     vvorked     3  mon-ms    or    le&s,    ■from  3+o  <o  wion+ha  ,  and    6  moin+K* 
or  more 


56o 


HOSPITAL   COMMITTEE 


Diagram   2 
All  Institutions  of    Department  of  Public  Charities 

COMPARED  "WITH    BeLLEVUE    AND  ALLIED     HoaPlTALS 

Ratio  of  number  of  employees  to  number  of  positions 


■  gvad 


160-168     i  ^linstlVu+ions 


Year  1908 

Percentage     of    dtscK^>.rges. 

\ooy.  2/?OV!  300-/  4O0-/( 

■ 1      I 

I  TBZ  posVtions  Avera^  S2lary^»33 


(Bsilevue  Vias  no  corresponding    &riAe) 


$  180-264 


All  insHiu-Vions       [ 


255  posit.  Avsra^ salary  ^219 
4-i5  pos'.t. 


#300420 


All 


BelU 


165  pos'ii.  Ave ra^ salary  ^3Z3 
30    posit. 


*4SO-720 


All 


&llffVU 


77  posi+.  Av<?ra&  saliiy  $  547 
38   poai-t. 


Year  1911 

Fercen+aga  o-f  dischargee. 


$60-168 


f  180-264. 


190-/ 

2qo-/.                      300  X 

All  ins-i-t-httions                                                             |       < 

(Bellsv\ie  h&6  r 

0  corresponding   g'rade) 

All  ins+Hu+ions        | 

Bellevue                                                                                      I 

676  JM31+.  Avcra^ssJery  ^t38 


565  posLt.  Avera^  salary  ^«04 


f300-420 


All 


Bdle 


23s   posit.  Avcn>gftsal«;y  §335 
80      po»i.t. 


f480-:J2O 


All 


Bel  lev  uc 


86    posii.  ..'Wcro^  salary  ^etio 
49     posit. 


HOSPITAL   HELPERS  561 

had  increased  from  255  in  1908  to  565  in  1911.  Although  the  number 
employed  had  somewhat  more  than  doubled  in  the  4  years,  it  had  not  materi- 
ally changed  the  percentage  of  discharges.  This  condition  would  naturally 
be  expected,  since  adding  numbers  to  a  particular  grade  should  not  affect 
the  percentage  of  discharges  in  such  grade  if  the  number  added  to  the  grade 
were  of  the  same  class  as  those  previously  employed  in  that  grade.  The 
same  facts  may  be  noted  in  connection  with  grades  $300  to  $420.  The 
nimiber  in  these  grades  was  increased  during  the  period,  but  the  per- 
centage of  discharges  remained  about  the  same. 

It  will  be  recalled  that  in  Bellevue  and  Allied  Hospitals  none  were 
employed  under  the  $180  grade,  but  in  this  Department  the  percentage 
of  discharges  in  the  group  of  grades  from  $180  to  $264  was  somewhat 
larger  than  the  grades  $60  to  $168  in  the  Department  of  Public  Charities. 
This  is  true  both  for  the  years  1908  and  191 1.  On  these  facts  being 
presented  to  some  officials  in  both  the  Department  of  Public  Charities 
and  the  Department  of  Bellevue  and  Allied  Hospitals,  the  only  explanation 
that  was  offered  was  that  Bellevue,  being  situated  on  the  mainland,  where 
saloons  were  easily  accessible,  probably  produced  a  larger  number  of  dis- 
charges owing  to  drunkenness  than  would  have  occurred  at  the  Island 
institutions  in  the  Department  of  Public  Charities.  In  order  to  analyze  this 
suggestion  a  comparison  was  made  between  Bellevue  and  Allied  Hospitals 
and  Kings  County  Hospital,  of  the  Department  of  Public  Charities,  located 
on  the  mainland  in  Brooklyn. 

In  Diagram  No.  3  the  comparison  noted  above  between  the  percentage 
of  discharges  in  Kings  County  Hospital  and  those  in  Bellevue  is  set  forth. 
Kings  County  Hospital  has  more  nearly  abolished  the  grades  under  $180 
than  any  of  the  other  institutions  in  the  Department  of  Public  Chari- 
ties, and  may  be  said  to  occupy  a  position  midway  between  the  average 
in  the  Department  of  Public  Charities  and  the  condition  existing  in  Belle- 
vue. An  examination  of  Diagram  No.  3  will  show  that  the  percentage  of 
discharges  in  each  of  the  grades  was  somewhat  less  in  Kings  County  Hos- 
pital than  in  Bellevue,  though  not  so  great  a  difference  is  shown  as  the 
average  for  the  whole  Department  of  Charities.  This  fact  seems  clear, 
however,  that  if  the  proximity  of  saloons  produces  a  larger  number  of 
discharges,  it  did  not  produce  as  great  an  effect  upon  the  employees  in 
Kings  County  as  in  Bellevue. 

It  might  be  said  that  the  larger  number  of  discharges  in  Bellevue  than 
in  the  institutions  of  the  Department  of  Public  Charities  might  be  due  to 
still  other  causes;  namely,  difference  in  administration,  stringency  of  rules 
and  regulations,  or  to  the  personnel  of  the  supervising  officers.  In  order 
to  secure  a  basis  into  which  these  considerations  might  not  enter  it  was 
deemed  best  to  compare  Bellevue  with  itself  when  it  employed  Helpers  in 
grades  under  $180. 

In  Diagram  No.  4  the  above  mentioned  comparison  is  made.  In  1903 
Bellevue  employed  108  Helpers  in  grades  ranging  from  $120  to  $150.  In 
1908  all  of  these  grades  had  been  dropped.  By  comparing  the  diagrams 
for  these  2  years  it  will  be  seen  that  in  1903  the  grades  from  $120  to  $150 
showed  430  per  cent,  of  discharges;  grades  from  $180  to  $216,  350  per 
cent. ;  grades  from  $240  to  $300,  120  per  cent. ;  grades  $360  to  $480,  60  per 
cent.  In  1908,  previous  to  which  time  the  lower  grades  had  been  dropped, 
the  grades  $180  to  $216  showed  425  per  cent,  of  discharges,  as  compared 
with  350  per  cent,  in  the  same  grades  in  the  year  1903.  In  1908  the  grades 
$240  to  $300  showed  215  per  cent,  of  discharges,  as  compared  with  120 


562 


HOSPITAL   COMMITTEE 


DlAORAM    3 

Comparison  of  Kings  County  Hospital  and  Bellevue 
Hospital 

Comparative  length  of  service  in  the  different  grades 
Four  YEARS       1908  -  I9ii 


i-,     ,       ,  Percentiide  of  +o+eil  number  in  service  in  sacK  A-ade 

Ifearly  salary  *  _       " 


|in  e&ch  ^PA^e 


«1S2 


fZ40 

#300 
$360 


Kmg^  Coun+y  Hospital 


BeUgyug  HoaplVa> 


Km22_ 


KintfS 


T^ 


-wmz 


:^ 


t-  'v'Ct: 


^vyv;-v^:^vyi: 


i 


$384- 


$420 


#600 


J<'"tfs 


K"ig6     |T: 


IE 


$7^       If-lagiigyj^-iilj 


Idna 


l^'^^^as^^^CZ: 


In  o«rvice  3  tnon+hA  or   les» 


IS-^SiCS^       3+06  morrtfis 

6  tnon4Ka   or  more 


HOSPITAL   HELPERS 


563 


Bellevue     Hospital 
Ratio  of  number  of  employees  to  number  of  positions 
Comparison  between  years  1903  and  i^oe 


foreBcTi 
of  gVaa 

1. 120-150 
#  180-216 
$,240-300 
$360-460 


Year   1903 

Percertta^    of  discViarges 
\<?o% zpo-/.  S<?o'/. 


Aqoy. 


I108  txjsi'tiojis 

60  position* 
Aver.  sala»y  ^2S0' 

J?vgJ^i^S5l440 


f  120-150 
$180-216 
$240-300 
#360-480 


Year    1008 

Percentage    of  dischso-^s 
looj:  290'/.  300X 

(No  corresponding    rfrajes   "tnts   yea-r) 


12gposvtioJ)%i, 
Aver.  aeia.ryf  180 

2<ra  positions 
Avefc  salary  $Z5i> 

AvSr.  saiary^Ata 


564  HOSPITAL  COMMITTEE 

per  cent,  for  the  similar  grades  in  1903.  It  seems  evident  by  these  figures 
that  the  lower  grades  in  1903  acted  as  a  buffer  to  the  grades  from  $180 
upward,  and  kept  the  percentage  of  discharges  in  those  grades  down. 
When,  however,  these  lower  buffer  grades  were  abolished  the  grades  from 
$180  upward  increased,  so  that  the  percentage  of  discharges  equaled  the 
percentage  noted  in  connection  with  the  lower  grades  when  they  existed. 
It  seems  reasonably  certain,  therefore,  that  the  class  of  Helpers  formerly 
employed  in  grades  from  $120  to  $150,  when  those  grades  were  abolished, 
were  promoted  to  the  grades  above ;  namely,  those  occupying  the  lower 
grades  were  probably  promoted  to  grades  from  $180  to  $216,  and  those 
occupying  these  latter  grades  in  1903  were  promoted  in  1908  to  the  grades 
from  $240  to  $300.  That  is,  the  abolition  of  the  lower  grades  in  Bellevue 
and  the  raising  of  the  standard  of  pay  did  not  decrease  the  percentage  of 
discharges,  but  merely  transferred  and  promoted  the  same  class  of  persons 
serving  in  the  lower  grades  into  the  higher  grades,  which  transfer  and 
promotion  did  not  change  their  habits  nor  increase  the  constancy  of 
their  service.  When,  however,  we  compare  grades  $360  to  $480,  we  find 
that  they  showed  the  same  percentage  of  discharges  in  1903  and  in  1908. 
The  abolition  of  the  lower  grades  between  these  periods  did  not  affect  these 
higher  grades.  In  other  words,  the  class  of  persons  serving  in  the  lower 
grades,  with  few  exceptions,  did  not  reach  these  higher  grades. 

Dormitories  and  Food  for  Hospital  Helpers 

The  food  and  lodging  furnished  Hospital  Helpers  are  larger  items  in 
their  compensation  than  the  money  given  to  them  in  the  form  of  wages 
month  by  month.  Many  Hospital  Helpers  receive  not  to  exceed  $20  cash 
wages,  and  in  addition  to  this,  receive,  in  the  form  of  food,  lodging,  and 
laundry,  what  probably  amounts  to  not  less  than  $25  a  month.  Food  and 
lodging  cannot  be  calculated  solely  on  the  basis  of  money  value.  Their 
character  may  contribute  largely  to  the  contentment  or  dissatisfaction  of 
the  Hospital  Helper ;  as  a  matter  of  fact,  the  nature  of  the  accommodations 
and  food  furnished  probably  do  enter  very  largely  into  the  regularity  and 
constancy  of  the  service  of  the  Helper.  It  is  highly  probable  that  the  City 
receives  more  service  for  the  money  it  expends  in  dormitories  and  food 
than  for  that  which  it  expends  directly  in  the  form  of  wages.  A  badly 
housed  and  poorly  fed  workman  is  apt  to  manifest  his  discontent  by  giving 
poor  service,  and  by  speedy  desertion  of  his  task. 

The  City  should  be  able  to  furnish  dormitory  accommodations  for 
Hospital  Helpers  at  a  cost  not  exceeding  $600  per  bed.  (Details  of  this 
estimate  are  furnished  in  another  section  of  the  Report.)  The  annual 
carrying  and  repair  charge,  estimated  at  5J4  per  cent,  of  this  amount, 
would  be  $33  per  year,  or  $2.75  per  month.  The  Department  of 
Public  Charities  has  for  years  strongly  urged  that  the  wages  of  Hospital 
Helpers  be  increased  from  $120  per  year  to  $240  per  year,  or  an  increase 
of  $120  per  year,  being  $10  per  month.  It  is  highly  probable  that  better 
service  would  be  secured  by  paying  a  lower  wage  and  at  the  same  time 
furnishing  good  sleeping  quarters  and  food,  than  by  paying  a  higher  wage 
combined  with  poor  accommodations  and  food.  It  is  practically  impossible 
to  prove  this  assertion,  owing  to  the  many  factors  entering  into  the  Hos- 
pital Helper  problem.  The  situation  in  Kings  County  Hospital,  however, 
seems  to  substantiate  this  theory.  During  the  last  few  years  the  lower 
grades  have  gradually  been  dropped  in  Kings  County,  so  that  during  the 


HOSPITAL   HELPERS  565 

year  191 1  few  Helpers  were  employed  under  the  grade  of  $240.  At  the 
same  time  the  sleeping  accommodations  have  been  worse  than  in  any  other 
hospital  of  the  Department.  Helpers  have  been  housed  in  barn-like  wooden 
structures,  cold  and  uninviting,  with  the  most  meager  bathing  and  toilet  fa- 
cilities, with  practically  no  common  lounging  or  reading  room  accommoda- 
tion, and  in  practically  all  regards  a  very  uninviting  and  unsatisfactory 
place  in  which  to  live  and  sleep.  It  seems  highly  probable  that  these  poor 
accommodations  have  in  quite  a  measure  accounted  for  the  fact  that  the 
percentage  of  discharges  has  been  materially  higher  in  Kings  County  Hos- 
pital than  in  the  other  institutions  of  the  Department  of  Public  Charities, 
regardless  of  the  fact  that  the  wages  paid  are  materially  higher  in  the 
former  institution.  These  assumptions  are  supported  by  the  testimony 
of  a  number  of  Hospital  Helpers  with  whom  the  Committee's  representa- 
tives have  talked,  and  also  by  the  Superintendent  of  Kings  County  Hos- 
pital, who  states  that  not  infrequently  a  Helper  leaves  the  institution's 
service  because  of  the  poor  dormitory  accommodations. 

If  the  City  is  to  retain  the  lower  grades  of  Hospital  Helpers,  as  it 
seems  necessary  to  do  for  some  years  to  come,  it  would  seem  a  warranted 
expenditure  to  furnish  better  dormitory  accommodations  than  are  at  pres- 
ent provided.  The  additional  expenditure  would  probably  secure  a  greater 
regularity  in  the  service  and  a  higher  grade  of  Helpers. 

The  food  served  to  the  Hospital  Helpers  is  of  good  quality  and  sufficient 
in  quantity.  It  is,  however,  neither  well  cooked  nor  well  served  in  some 
of  the  institutions.  Provision  was  made  in  the  Budget  for  1913  for  higher 
pay  for  the  head  cook  in  each  of  the  institutions  and  this  should  tend  to 
correct  the  difficulty  mentioned. 

The  dormitory  accommodations  in  Metropolitan  Hospital  are  reason- 
ably satisfactory,  or  will  be  as  soon  as  the  new  male  dormitory  now  under 
construction  is  completed.  The  kitchen  and  dining  room  service,  how- 
ever, is  exceedingly  poor.  In  the  service  building  now  used  are  fed 
nearly  all  of  the  Hospital  Helpers,  besides  the  mechanics  and  clerks,  in 
all  about  375  daily,  on  a  floor  space  of  about  3,400  square  feet,  which  indi- 
cates a  serious  overcrowding.  The  building  is  very  old  and  badly  out  of 
repair,  and  of  such  character  that  repairs  would  not  be  warranted.  A  new 
service  building  should  be  erected  as  soon  as  possible. 

The  dormitory  accommodations  at  City  Hospital  are  reasonably  good, 
except  in  the  case  of  the  male  overflow  dormitory,  which  furnishes  accom- 
modations for  about  50  men.  This  is  a  one-story  wooden  building,  with 
very  inadequate  bathing  and  toilet  facilities.  It  should  be  replaced  by  a 
permanent  building,  but  preferably  not  before  the  service  building  is  built 
at  Metropolitan  Hospital  and  new  dormitories  at  Kings  County  Hos- 
pital. The  kitchen  and  dining  room  service  at  City  Hospital  is  good.  A 
new  service  building  affords  ample  dining  room  space  and  good  kitchen 
service.  The  cooking  is  acceptably  done,  and  there  should  be  no  ground 
of  complaint  on  the  part  of  the  Helpers  as  to  the  character  of  food  or 
service. 

The  dormitory  accommodations  for  Helpers  at  Kings  County  Hospital 
are  very  poor  and  inadequate.  The  orderlies  are  quartered  in  the  old 
nurses'  home,  which  is  a  satisfactory  dormitory  in  the  matter  of  space,  and 
toilet  and  bathing  facilities.  The  clerical  help  is  housed  in  the  building 
known  as  the  "Stewart  Building,"  built  for  the  male  insane,  which  is  still 
in  a  fair  condition  of  repair,  and  furnishes  acceptable  accommodation.  The 
dietitian,  kindergartner,  and  some  attendants  are  housed  in  the  building 


566  HOSPITAL  COMMITTEE 

originally  built  for  female  insane,  corresponding  in  accommodation  to 
the  Stewart  Building.  Some  of  the  female  attendants  are  quartered  in  the 
building  formerly  intended  for  isolation  purposes,  which  serves  very  ac- 
ceptably its  present  purpose,  except  for  the  lack  of  toilet  facilities.  About 
40  men  and  29  women  are  accommodated  in  two  one-story  wooden  pavilions, 
divided  into  small  rooms  by  means  of  wooden  partitions,  with  2  beds  in 
a  room,  and  with  extremely  meager  toilet  and  lavatory  facilities.  There  is 
no  common  sitting  or  reading  room,  and  the  whole  atmosphere  of  the 
place  is  depressing.  About  17  ward-maids  are  quartered  in  the  basement  of 
the  main  building,  which  space  should  be  devoted  to  hospital  rather  than 
dormitory  purposes.  Accommodations  for  Helpers  are  also  provided  on 
the  first  floor  of  the  main  building,  where  about  19  are  provided 
with  sleeping  quarters.  This  space  should  be  devoted  to  hospital  purposes 
rather  than  to  the  sleeping  quarters  of  the  help.  About  23  Helpers  are 
quartered  in  the  new  nurses'  home,  which  space  will  be  needed  for  addi- 
tional pupil  nurses.  About  40  Helpers  now  sleep  at  home  who  should  be 
quartered  at  the  Hospital.  The  168  Helpers  above  noted  should  be  provided 
for  in  new  dormitories,  and  when  these  dormitories  are  built  they  should 
furnish  accommodations  for  not  less  than  200,  to  provide  for  the  additional 
help  required  for  the  new  children's  pavilion,  and  the  new  wing  which  is 
soon  to  be  built. 

The  male  Helpers  at  Children's  Hospital  and  Schools  on  Randall's  Island 
are  quartered  in  a  three-story  brick  building  which  provides  sufficient  dormi- 
tory and  toilet  accommodations.  The  female  help  is  quartered  on  the  upper 
floors  of  what  is  known  as  the  laundry  and  kitchen  building.  In  these 
dormitories  no  provision  is  made  for  space  for  clothing,  except  in  boxes 
under  the  beds.  The  toilet  and  lavatory  facilities  are  very  inadequate  and 
no  bathing  facilities  are  furnished  for  about  50  women.  About  100  Helpers 
must  use  the  toilet  and  bathing  facilities  contained  in  2  rooms  about  12  by 
12  feet  in  size.  The  plumbing  is  old  and  unsanitary,  and  the  entire  building 
is  in  a  bad  condition  of  repair.  The  seamstresses  are  housed  in  the  Infants' 
Hospital,  which  space  should  more  properly  be  used  for  patients.  Dormi- 
tory accommodations  for  the  women  are  very  urgently  needed.  The 
dining  room  accommodations  are  reasonably  satisfactory,  and  any  improve- 
ment in  this  service  should  be  postponed  until  additional  dormitory  accom- 
modations are  provided. 


2.    PROPOSED  SALARY  AND  WAGE  SCHEDULE  FOR 
THE  DEPARTMENT  OF  PUBLIC  CHARITIES 


THE  INVESTIGATION 

Your  Committee  has  endeavored  to  standardize  the  wages  and  salaries 
in  the  institutions  of  the  Department  of  Public  Charities.  This  phase  of 
the  work  was  begun  in  June,  19 12,  and,  inasmuch  as  it  was  desired  that 
the  budget  which  would  be  considered  in  the  following  October  should 
be  based  upon  such  standardization,  it  became  necessary  to  restrict  the 
work  to  a  limited  number  of  institutions.  The  institutions  standardized  are 
the  following: 

Metropolitan  Hospital 

City  Hospital 

Kings  County  Hospital 

Home  for  the  Aged  and  Infirm,  Manhattan 

Home  for  the  Aged  and  Infirm,  Brooklyn 

Farm  Colony 

The  method  pursued  was  to  interview  the  various  heads  of  departments ; 
examine  the  tasks  in  each  of  the  institutions;  ascertain  the  number  em- 
ployed on  particular  tasks ;  the  character  of  the  employees ;  length  of  time 
in  the  particular  institution ;  and  the  opinion  of  the  one  interviewed  as  to  the 
probable  effect  of  an  increase  or  decrease  of  wage  on  the  standard  of 
service.  The  payroll  was  then  checked  and  detailed  information  recorded 
with  regard  to  each  employee;  setting  forth  the  time  of  entering  the  service, 
character  of  work  performed,  and  wage  or  salary.  In  gathering  such 
information  the  work  of  the  institution  was  divided  into  about  sixty  tasks, 
and  the  number  noted  in  connection  with  each  task.  Subsequently,  sim- 
ilar tasks  were  compared  in  the  different  institutions  to  ascertain  the  com- 
parative number  employed  in  the  performance  of  such  tasks.  Where  the 
work  corresponded  to  work  in  the  commercial  field  opinion  was  secured  as 
to  wages  and  hours  in  such  commercial  work.  This  applied  especially  to 
stenographic  work  and  telephone  service. 

The  information  gained  in  connection  with  an  examination  of  the  Hos- 
pital Helper  service  was  used  in  connection  with  establishing  the  wage 
schedule.  One  of  the  conclusions  reached  in  the  former  examination  was 
that  it  was  deemed  advisable  to  retain  a  grade  of  $120  per  year,  and  to 
automatically  promote  those  having  served  in  that  grade  3  months  to  a 
$180  grade,  irrespective  of  other  qualifications,  on  the  assumption  that 
any  Helper  who  had  remained  in  his  position  for  a  period  of  3  months 
had  demonstrated  that  he  was  worth  the  additional  amount  provided  in  the 
next  higher  group.  The  arguments  for  retaining  the  grades  of  $120,  $180, 
and  $240  have  been  set  forth  on  preceding  pages.  The  schedule  provides 
that  all  promotions,  except  the  one  noted  above,  are  to  take  place  only 
after  a  year's  service  (except  in  the  $180  and  $240  grades,  where  2  years 
are  required),  and  on  recommendation  of  the  Commissioner,  based  on  the 
efficiency  of  the  service  rendered. 

It  was  deemed  advisable  to  draw  a  distinct  line  between  the  class  to  be 
called  Hospital  Helpers  and  those  who  would  be  listed  under  a  title.  It  is 
recommended  that  all  employees  receiving  $480  or  less  be  called  Hospital 
Helpers,  and  all  receiving  more  than  that  amount  be  employed  by  title. 

569 


570  HOSPITAL   COMMITTEE 

In  the  plan  proposed  the  employees  are  divided  into  grades,  13  in  num- 
ber, and  each  grade  is  subdivided  into  groups.  Group  "A"'  provides  for 
the  highest  salary  that  can  be  secured  in  any  grade  after  service  has 
been  rendered  in  tiie  group  or  groups  below.  Length  of  service  necessary 
for  promotion  may  be  reckoned  in  the  Department  as  a  whole,  not  in 
any  particular  institution,  thus  making  it  possible  to  transfer  from  insti- 
tution to  institution  without  sacrifice  of  grade-standing. 

The  rate  of  increase  of  wage  or  salary  is  $60  per  year  in  the  first 
7  grades.  Grades  VIII  to  XI  provide  for  a  graduated  increase  yearly 
of  $120  per  year.  Grades  XII  and  XIII  provide  for  a  larger  and  arbitrary 
yearly  increase,  not  based  upon  the  divisibility  of  such  amount  by  12,  or 
the  number  of  months  in  a  year. 

Aside  from  providing  that  like  work  shall  receive  like  wages  or  salary 
throughout  the  institutions  of  the  Department,  and  also  a  basis  of  promo- 
tion for  length  of  service,  the  principal  changes  to  be  effected  by  the  Salary 
and  Wage  Schedule  as  presented  are  as  follows : 

1.  A  line  will  be  drawn,  below  which  all  employees  are  Hospital 
Helpers  and  above  which  all  are  distinctive  titled  positions. 

2.  The  wages  of  all  those  serving  patients  or  working  in  wards  will 
be  raised,  with  the  hope  that  such  increased  pay  will  secure  a  better  class 
of  employees. 

3.  Some  positions  of  marked  responsibility,  such  as  Pharmacist  and 
Head  Cook,  will  be  materially  increased. 

The  adoption  of  this  schedule  providing  for  yearly  promotion  will  prob- 
ably not  require  a  materially  larger  annual  appropriation  than  that  pro- 
vided in  the  budget  of  1913  '■  for  a  like  number  of  employees. 

About  70  per  cent,  of  those  serving  in  Grade  I,  constituting  a  large 
proportion  of  the  employees  of  the  institutions,  will  probably  remain  in  the 
$120  group.  There  was  about  the  same  number  in  this  group  in  the  1913 
budget. 

About  70  per  cent,  of  those  in  Grade  II  will  probably  remain  in  the 
service  less  than  6  months ;  that  is,  not  to  exceed  30  per  cent,  of  those  in 
this  grade  will  serve  in  the  $240  group.  The  budget  for  1913  provided 
approximately  this  proportion  of  employees  in  the  $180  and  $240  groups. 

The  lowest  group  of  Grade  III  is  $240.  In  this  group  it  may  be  ex- 
pected that  about  70  per  cent,  will  serve  less  than  6  months ;  that  is,  not  to 
exceed  30  per  cent,  of  those  serving  in  this  grade  may  be  expected  to 
reach  the  $360  group  of  the  grade.  In  the  budget  for  1913  more  than  30 
per  cent,  were  in  the  highest  group  of  this  grade. 

In  Grade  IV  about  50  per  cent,  of  the  employees  in  each  of  the  3 
groups— $360,  $420,  $480 — may  be  expected  to  leave  the  service  each  year. 
At  this  ratio,  within  3  years  about  one-third  of  the  employees  would  be  in 
each  of  the  groups,  so  that  the  $420  group  would  represent  the  average 
for  the  grade.  In  the  budget  for  1913  slightly  less  than  one-third  of  the 
employees  in  this  grade  were  in  Group  "A,"  and  nearly  two-thirds  were  in 
Group  "C,"  comparatively  few  having  been  placed  in  Group  "B."  Since  a 
portion  of  Group  "C"  will  be  promoted  to  Group  "B,"  with  an  increase  of 
$60  per  year  in  salary,  the  appropriation  necessary  to  provide  for  the 
employees  in  this  group  will  have  to  be  somewhat  increased.    It  is  probable 

'This  report  was  completed  before  the  budget  of  1914  was  made  up,  but  inas- 
much as  it  was  not  submitted  to  the  Board  of  Estimate  and  Apportionment  its  rec- 
ommendations did  not  enter  into  the  1914  budget. 


SALARY  AND  WAGE  SCHEDULE  571 

that  it  may  require  $4,000  or  $5,000  to  provide  for  the  promotions  in  this 
grade  in  the  budget  of  1914.^  Thereafter,  those  in  this  grade  leaving  the 
service  should  approximately  balance  the  promotions  which  would  take 
place  in  the  grade.  Thus  an  equilibrium  would  be  established  by  the  budget 
of  1914  which  would  thereafter  be  maintained. 

The  number  of  employees  in  the  title  grades  from  VI  to  XIII  are 
a  small  proportion  of  the  total  number  employed  in  the  institutions,  and, 
inasmuch  as  a  good  proportion  of  these  were  placed  in  the  highest  group 
of  their  respective  grades  by  the  budget  of  1913,  it  is  improbable  that  the 
promotions  provided  for  in  the  schedule  will  require  materially  larger 
appropriations  in  subsequent  years  than  in  the  budget  for  1913. 

If  this  schedule  is  adopted,  it  is  probable  that  not  more  than  from  $5,000 
to  $10,000  additional  to  the  budget  for  1913  will  be  required  to  provide  for 
the  promotions  incorporated  in  the  schedule. 


Definition  of  Certain  Services 

With  few  exceptions  the  titles  in  the  following  Wage  and  Salary  Sched- 
ule sufficiently  describe  the  character  of  the  positions  and  the  work  con- 
nected with  each.  It  seems  desirable,  however,  to  define  somewhat  more 
fully  the  functions  of  the  following  positions : 

Attendant  or  Orderly.  The  term  "Attendant  or  Orderly"  is  intended 
to  apply  either  to  a  male  or  female  caring  for  patients  under  the  super- 
vision of  a  trained  nurse  or  trained  attendant.  The  character  of  service 
which  may  be  performed  for  patients  by  an  Attendant  or  Orderly  is  to  be 
subject  to  definition  and  regulation  by  the  Superintendent  of  the  hos- 
pital. 

Ward  Cleaner  or  Wardmaid.  A  Ward  Cleaner  or  Wardmaid  is  to 
have  the  duty  of  cleaning  wards  and  accessory  rooms ;  to  move  beds 
and  stretchers ;  to  make  beds  when  required ;  but  to  perform  no  service 
with  or  for  patients. 

Payroll  Clerk.  A  Payroll  Clerk  as  listed  in  Grade  VIII  is  intended 
to  fulfill  the  duties  of  the  Chief  Clerk  of  an  institution  where  the  store 
room  books  are  not  kept  by  a  Steward.  His  functions  should  involve 
not  only  the  making  out  of  payrolls,  but  also  the  supervision  of  all 
records  and  reports. 

Assistant  Payroll  Clerk.  The  position  of  Assistant  Payroll  Clerk  is 
intended  to  include  only  the  making  out  of  the  payrolls  and  the  perform- 
ance of  other  incidental  work  assigned  by  the  Payroll  Clerk  or  Superin- 
tendent. The  function  of  supervising  the  general  records  of  the  institu- 
tion when  an  Assistant  Payroll  Clerk  only  is  employed,  is  supposed  to 
reside  in  the  Superintendent. 

Mechanician.  A  Mechanician  is  an  employee  familiar  with,  and  able 
to  operate  and  keep  in  repair,  simple  forms  of  machinery. 


Salary  and  Wage  Schedule 

All  salaries  herein  stated  are  based  on  maintenance  at  the  institutions. 
When  deemed  necessary  and  advisable  the  Commissioner  of  Charities  may 
permit  any  employee  receiving  $480  or  above  to  take  a  portion  or  all  of 

'  See  footnote  about  1914  budget  on  page  570. 


572  HOSPITAL   COMMITTEE 

his  maintenance  away  from  the  institution.  In  an  institution  where  the 
dormitory  accommodation  is  not  sufficient  for  all  employed,  the  Commis- 
sioner may  grant  maintenance  allowance  to  such  persons  as  cannot  be 
maintained  at  the  institution.  In  case  such  exemption  is  made,  in  lieu  of 
maintenance  and  laundry  an  employee  should  receive,  in  addition  to  his 
salary,  five  dollars  per  month  for  the  particular  meal  of  the  day  not  eaten 
in  the  institution  and  five  dollars  per  month  for  lodging  not  had  in  the 
institution.  In  the  annual  estimate,  the  Commissioner  of  Charities  should 
insert  a  separate  item  for  such  outside  maintenance,  specifying  the  amount 
for  each  position. 

In  Grade  I  promotions  are  to  take  place  automatically  at  the  expiration 
of  the  term  of  service  indicated. 

Except  in  Grade  I,  all  promotions  are  to  be  made  on  the  basis  of  effi- 
ciency, but  only  after  service  has  been  rendered  for  the  period  indicated 
in  the  various  grades  and  groups.  Promotions  are  to  be  made  by  the  Com- 
missioner of  Charities  on  recommendation  of  the  superintendent  of  the 
institution  in  which  such  promotion  is  desired. 

All  persons  entering  Group  B  of  Grades  I  and  II  are  to  be  required 
to  serve  a  probationary  period  of  i  week  without  pay  other  than  mainte- 
nance. 

Promotions  may  be  made  to  the  lowest  group  of  a  higher  grade,  on 
merit,  only  after  the  person  to  be  promoted  has  served  in  Group  A  of  the 
grade  from  which  promotion  is  to  be  made. 

The  Civil  Service  Commission  is  to  be  notified  of  all  changes  in  position 
or  personnel  in  all  grades  above  Grade  I,  such  notification  to  include  the 
title  of  the  position  as  listed  in  this  Salary  and  Wage  Schedule. 

Appropriations  for  Grades  I,  II,  III,  and  IV  are  to  be  made  in  blanket 
amounts,  and  those  employed  in  these  grades  to  be  known  as  Hospital 
Helpers. 

Grade  I.  To  indude  those  perfonning  unskilled  labor  not  in  quarters  occupied  by  patients, 
or  light  work  capable  of  being  performed  by  old  persons;  a  class  of  work  involving  little 
responsibility,  where  change  of  personnel  could  be  made  with  comparative  frequency 
without  materially  affecting  the  work  in  hand,  such  as: 

Bathroom  Helper 

Barber's  Helper 

Butcher's  Helper 

Caretaker,  for  patients'  clothing 

Carpenter's  Helper 

Cleaner,  for  floors,  windows,  etc. 

Clerk,  for  routine  duties 

Clockman 

Coal  Passer 

Crematory  Helper 

Dish  Washer 

Dockman 

Driver,  for  work  or  delivery  carts  or  wagons 

Electrician's  Helper 

Floder 

Groundman 

Ice  Plant  Helper 

Ironer 

Kitchen  Helper 

Laundry  Machine  Operator 

Laundry  Helper 

Locksmith 

Mason's  Helper 

Morgue  Helper 


SALARY  AND   WAGE  SCHEDULE  573 

Painter's  Helper 

Pan  try  maid 

Pantryman 

Plasterer's  Helper 

Plumber's  Helper 

Pharmacist's  Helper 

Porter 

Runner 

Sexton 

Seamstress 

Shoe  Repairer 

Sorter 

Stable  Worker 

Steam-tableman 

Sterilizer 

Storehouse  Helper 

Tailor's  Cutter 

Tinsmith  ' 

Tub  Washer 

Vegetable-man 

Waiter  or  Waitress,  other  than  in  Grade  II 

Salary.     Group  B.     Those  having  served  less  than  three  months $120 

Group  A.     Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  three  months  or  more 180 

Grade  II.  To  include  those  performing  unskilled  work,  yet  requiring  a  certain  degree 
of  responsibility  and  somewhat  more  constancy  of  service  than  provided  for  in  Grade  I. 
Persons  serving  in  this  grade  may  perform  manual  or  physical  work  in  connection  with 
ward  service,  but  should  have  no  direct  care  of  patients,  such  as: 

Boilerman 

Chambermaid 

Counterman 

Elevator  Attendant 

Food  Runner 

General  Service-girl 

Laboratory  Assistant,  Clinical 

Laundryman's  Helper 

Letter  Carrier 

Porter,  in  nurses'  homes,  to  begin  service  in  Group  "A" 

Tailor 

Telephone  Operator,  Night,  in  hospitals  having  no  night  emergency  ambulance 

service 
Ward  Cleaner 
Wardmaid 
Ward  Kitchenmaid 
Waiter  or  Waitress,  serving  in  staff  house  and  nurses'  homes,  to  begin  service  in 

Group  "A" 

Salary.     Group  B.     Those  serving  in  the  Department  less  than  one  year $180 

Group  A.     Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  or  more 240 

Grade  III.  To  include  those  having  manual  trades,  but  working  largely  on  repairs; 
and  those  from  whom  honesty  and  reliability  may  be  expected,  but  not  involving  much 
supervision  or  oversight  of  subordinates,  such  as: 

Attendant  or  Orderly,  for  helpless  inmates  in  almshouses 

Bathroom  Attendant  in  Charge,  in  almshouses 

Barber 

Carpenter 

Clerk,  in  linenroom 

Clerk,  in  medical  record  office 

Cook,  Night 

Cook,  Plain 

Counterman,  Chief,  in  storeroom  of  iastitutions  or  wholesale  general  store 


574  HOSPITAL  COMMITTEE 

Electrician,  Assistant 
Engineer's  Helper 
Foreman,  Assistant 
Gardener,  Assistant 

Housekeeper  or  Cook,  for  officers  and  chaplains 
Housekeeper,  in  charge  of  cottages  in  almshouses 
Housekeeper,  Assistant 
Janitor 

Laundress,  Assistant 

Laundress,  First  Assistant,  in  almshouses 
Mason 

Mattress  and  Mattress-spring  Maker 
Mechanician,  Assistant 

Morgue  Keeper,  delivering  bodies  to  other  morgues 
Office  Assistant 
Painter 

Pharmacist's  Assistant 
Plasterer 
Plumber 

Sorter's  Assistant 

Sorting-room,  Foreman  of,  in  the  laundry 
Stables,  Foreman  of,  serving  one  or  two  institutions 
Telephone  Operator,  Day,  in  almshouse 
Waiter,  Head,  in  hospitals,  serving  less  than  500  persons 
Waiter  or  Waitress,  Head,  in  almshouses 

Waiter  or  Waitress,  serving  in  general  administration  officers'  quarters,  to  begin 
service  in  Group  "  B  " 

Salary.     Group  C.     Those  serving  in  the  Department  less  than  one  year $240 

Group  B.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  and  less  than  two 

years 300 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
for  a  period  of  two  years  or  more  and  in  the  next  lower  group  for  a  period 
of  one  year  or  more 360 

Grade  IV.  To  include  those  from  whom  constancy  of  service  should  be  expected,  and 
on  whom  responsibility  can  be  placed  for  accuracy  of  work;  or  those  having  ability  to 
oversee  or  supervise  a  limited  number  of  persons,  but  not  involving  much  skill  or  education 
in  any  particular  line,  such  as: 

Admitting  Office  Clerk 

Attendant  or  Orderly,  in  hospital 

Baker,  in  almshouse 

Butcher 

Clerk,  General 

Cook,  Head,  in  kitchen  in  staff  houses  and  nurses'  homes 

Cook,  First  Assistant,  in  kitchens  serving  500  or  more  persons 

Cook,  serving  in  general  administration  officers'  quarters,  not  to  be  promoted  beyond 

Group  B 
Copyist 

Driver  of  Motor  Trucks 
Driver  of  Horse  Ambulance 
Driver,  for  work  or  delivery  carts  or  wagons  making  periodic  deliveries  to  other 

institutions 
Gardener  in  Charge,  for  grounds  of  not  more  than  two  institutions 
Housekeeper 
Laboratory  Assistant 
Laundry,  First  Assistant,  in  hospitals 
Laundress  or  Laundryman  in  Charge,  in  almshouses 
Linenroom,  Head  of 
Matron,  Assistant 

Mechanic,  serving  more  than  one  institution 
Mechanician 

Morgue,  Keeper  of  General 
Medical  Record  Office,  Head  Clerk 


SALARY   AND   WAGE  SCHEDULE  575 

Payroll  Clerk,  Assistant 

Seamstress  in  Charge 

Supervisor,  Assistant,  in  almshouses 

Telephone  Operator,  in  hospitals  with  200  or  more  beds  and  night  emergency 

ambulance  service 
Waiter,  Head,  in  hospitals,  serving  500  or  more  persons 
Watchman 
X-ray  Operator,  Assistant 

Salary.     Group  C.     Those  serving  in  the  Department  less  than  one  year $360 

Group  B.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  and  less  than  two 

years 420 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
for  a  period  of  two  years  or  more  and  in  the  next  lower  group  for  a  period 
of  one  j'ear  or  more . . . .  r 480 

Note:     The  persons  serving  in  the  following  grades  to  be  estimated  for  by  title;  the 
number  under  each  title  and  group  to  be  stated. 

Grade  V.  To  include  those  performing  certain  kinds  of  services  requiring  specialized 
training  as  listed,  such  as: 

Auto  Engineman S  960 

Chaplains 450 

Deputy  Lay  Superintendent 1,000 

Internes,  Tuberculosis  Service,  Junior 240 

«                     "                  "         Senior 300 

"                    "                 "         House 360 

Psychopathic  Service,  Attendant,  Head 600 

"                   "        Trained  Nurse,  Supervising 720 

"      Head 600 

«                  "       Special  Officer 720 

Pupil  Nurse,  1st  year 120 

2d     "     144 

"         «        3d     "     ISO 

Superintendent  of  School  for  Nurses 1,800 

Superintendent  of  Nurses 1,200 

Trained  Nurse,  Head,  in  operating  room 840 

"  "       Supervisor: 

Those  serving  in  the  Department  less  than  one  year 720 

Those  having  rendered  consecutive  service  in  the  Depart- 
ment and  in  the  next  lower  group  for  a  period  of  one 

year  and  less  than  two  years 780 

Those  having  rendered  consecutive  service  in  the  Depart- 
ment for  a  period  of  two  years  or  more  and  in  the  next 

lower  group  for  a  period  of  one  year  or  more 840 

"  "       Head: 

Those  serving  in  the  Department  less  than  one  year 600 

Those  having  rendered  consecutive  service  in  the  Depart- 
ment and  in  the  next  lower  group  for  a  period  of  one 

year  or  more 660 

"            "       Post  Graduate 300 

Grade  VI.  To  include  those  of  responsibility,  performing  services  requiring  a  certain 
degree  of  technical  education;  or  those  of  sufficient  training  to  take  charge  of  the  workers 
in  a  division,  such  as: 

Baker 

Cook,  Head,  in  almshouses 

Counterman,  Head,  in  retail  general  store 

Dietitian 

Dietitian,  Assistant 

Engineer,  Chief,  where  plant  serves  less  than  300  beds,  or  serving  a  low  pressure 

plant,  to  be  known  as  Class  4 
Engineer,  Assistant,  serving  with  Class  3  Chief  Engineer 
Foreman  of  Laborers 


576  HOSPITAL  COMMITTEE 

Gardener  in  Charge,  for  grounds  of  more  than  two  institutions 

Instructor,  not  under  the  Department  of  Education 

Laundryman  or  Laundress  in  Charge 

Matron,  of  ahnshouses,  having  charge  of  more  than  300  and  less  than  900  inmates 

Matron,  in  hospitals,  having  general  oversight  and  performing  duties  of  dietitian 

Oiler 

Pharmacist,  Assistant 

Social  Service  Worker,  Assistant 

Supervisor,  Second  Assistant 

Supervisor  (male),  of  almshouses,  having  charge  of  more  than  300  and  less  than  900 

inmates 
Stables,  Foreman  of,  serving  more  than  two  institutions 
Stenographer 
Stoker 
Tailor 

Salary.    Group  C.     Those  serving  in  the  Department  less  than  one  year $600 

Group  B.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  and  less  than  two 

years 660 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
for  a  period  of  two  years  or  more  and  in  the  next  lower  group  for  a  period 
of  one  year  or  more 720 

Grade  VII.  To  include  those  capable  of  taking  charge  of  a  department;  or  one  in  a  posi- 
tion of  large  responsibility  in  a  smaller  institution;  or  an  assistant  to  a  position  of  large 
responsibility  in  the  larger  institutions  of  the  Department;  or  one  in  charge  of  a  large 
number  of  patients  or  inmates;  or  one  in  charge  of  work  requiring  not  only  several  years 
of  specialized  and  general  training,  but  also  some  years  of  experience  in  practical  work, 
such  as: 

Baker,  Chief 

Cook,  Chief,  in  hospitals,  cooking  for  not  less  than  500  persons 

Engineer,  Assistant,  serving  with  Class  2  Chief  Engineer 

Engineer,  Chief,  where  plant  serves  300  or  more  and  less  than  600  beds,  to  be  known 

as  Class  3 
Matron,  in  almshouses,  having  charge  of  more  than  900  inmates 
Hospital  Clerk 
Social  Service  Worker,  Head 
Supervisor,  Assistant 

Salary.     Group  C.     Those  serving  in  the  Department  less  than  one  year $780 

Group  B.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  and  less  than  two 

years 840 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
for  a  period  of  two  years  or  more  and  in  the  next  lower  group  for  a  period 
of  one  year  or  more 900 

Grade  VIII.  To  include  the  following  positions: 
Deputy  Superintendent  of  Training  School 
Engineer,  Chief,  where  plant  serves  600  or  more  and  less  than  1,500  beds,  to  be  known 

as  Class  2 
Engineer,  Assistant,  serving  with  Class  1  Chief  Engineer 
Pharmacist 

Storekeeper,  First  Assistant,  in  store  serving  three  or  more  institutions 
Steward 

Supervisor,  acting  in  the  capacity  of  Lay  Deputy  Superintendent 
X-ray  Operator 

Salary.     Group  C.     Those  serving  in  the  Department  less  than  one  year $960 

Group  B.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  and  less  than  two 

years 1,080 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
for  a  period  of  two  years  or  more  and  in  the  next  lower  group  for  a  period 
of  one  year  or  more 1,200 


SALARY   AND   WAGE  SCHEDULE  577 

Grade  IX.    To  include  the  following  positions: 
Alienist,  Second  Assistant 
Director  of  Laboratory,  Assistant 
Electrician,  in  charge  of  institution  lighting  plant 

Engineer,  where  plant  serves  1,500  or  more  beds,  to  be  known  as  Class  1 
Pathological  Chemist 

Salary.     Group  B.     Those  serving  in  the  Department  less  than  one  year $1,320 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  or  more 1,440 

Grade  X.    To  include  the  following  positions: 
(No  one  at  present  included  in  this  grade) 

Salary.     Group  C.     Those  having  served  in  the  Department  less  than  one  year $1,560 

Group  B.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  and  less  than  two 

years 1,680 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
for  a  period  of  two  years  or  more  and  in  the  next  lower  group  for  a  period 
of  one  year  or  more 1,800 

Grade  XL     To  include  the  following  positions: 
Alienist,  First  Assistant 
Medical  Superintendent,  Deputy 
Superintendent,  in  almshouses,. 

Salary.    Group  C.    Those  serving  in  the  Department  less  than  one  year $1,800 

Group  B.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  one  year  and  less  than  two 

years 1,980 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
for  a  period  of  two  years  or  more  and  in  the  next  lower  group  for  a  period 
of  one  year  or  more 2,100 

Grade  XII.    To  include  the  following  positions: 
Alienist,  Resident 

Director  of  Laboratory,  serving  hospitals  having  jointly  from  10,000  to 
25,000  admissions  yearly 

Salary.     Group  B.     Those  serving  in  the  Department  less  than  two  years $2,700 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  two  years  or  more 3,000 

Grade  XIII.    To  include  the  following  positions: 

Director  of  Laboratory,  serving  hospitals  having  jointly  more  than  25,000 

and  less  than  35,000  admissions  yearly 
Superintendents,  Medical  or  Lay,  for  hospitals  having  500  or  more  and  less 
than  1,000  bed  capacity,  exclusive  of  tuberculosis  service 

Salary.     Group  B.     Those  serving  in  the  Department  less  than  two  years $3,500 

Group  A.  Those  having  rendered  consecutive  service  in  the  Department 
and  in  the  next  lower  group  for  a  period  of  two  years  or  more 4,000 


Section  IX.— FOOD,  BUILDINGS,  AND  CONTROL  FORMS 

1.  Handling  of  Food   and   Food  Waste 

2.  Character   and   Costs  of  Hospital   Buildings 

3.  Internal     Control     Forms     Suggested      for     Bellevue 

Hospital 


I.  HANDLING  OF  FOOD  AND  FOOD  WASTE 


FOREWORD 

A  limited  examination  has  been  made  of  the  methods  of  handling  food 
in  the  three  Departments  under  investigation.  Inasmuch  as  the  Board  of 
Estimate  and  Apportionment  has  established  certain  specifications  for  food, 
and  the  Comptroller's  Department  stations  men  at  the  institutions  to  com- 
pare food  received  with  the  specifications,  and  also  to  check  the  same 
deliveries  on  the  invoices,  it  vi^as  deemed  unnecessary  to  inquire  into  this 
phase  of  food-handling.  The  inquiry  has  been  confined  to  an  examination 
of  the  proportions  of  different  kinds  of  food  used;  the  method  of  requisi- 
tioning food  from  the  Storehouse ;  the  method  of  serving  food ;  and  the 
methods  used  to  regulate  the  amount  of  waste. 

An  inquiry  into  the  methods  of  controlling  waste  was  made  in  Bellevue 
Hospital  only.  Owing  to  a  lack  of  time  it  was  impossible  to  make  such  an 
inquiry  in  all  of  the  hospitals,  and  Bellevue  was  chosen  for  this  purpose  be- 
cause of  the  full  and  cordial  cooperation  on  the  part  of  the  Hospital  offi- 
cers. Although  this  phase  of  the  inquiry  has  been  almost  entirely  con- 
fined to  Bellevue  Hospital,  it  is  reasonable  to  assume  that  uncontrolled 
waste  is  quite  as  prevalent  in  the  hospitals  of  the  Department  of  Charities, 
since  in  that  Department  the  gross  amount  of  meat  served  to  a  small  sum- 
mer census  was  as  much  as  that  served  to  the  large  winter  census,  which 
would  seem  to  indicate  that  there  was  a  waste  of  food  during  the  summer, 
or  that  the  patients  were  underfed  during  the  winter. 

The  amounts  of  food  used  in  the  different  hospitals  have  been  set  forth 
in  tables,  which  contain  all  of  such  items,  with  the  exception  of  fresh 
fruits,  fresh  vegetables,  and  cooking  accessories.  These  were  omitted 
because  such  omissions  were  found  best  in  arranging  a  table  similar  in 
form  to  the  one  herein  shown  for  use  in  determining  the  amount  of  food 
consumed  in  the  State  institutions  of  New  York,  Indiana,  and  Iowa,  by 
your  Director,  and  published  in  a  report  entitled  "Fiscal  Control  of  State 
Institutions."  In  that  investigation  it  was  necessary,  when  comparing  State 
institutions,  to  exclude  fresh  fruits  and  fresh  vegetables,  owing  to  the  fact 
that  some  of  the  institutions  produced  large  quantities  of  these  foods,  and 
were  not  accurate  in  their  account  of  the  amount  consumed.  Inasmuch  as 
these  two  classes  of  food  omitted  are  a  small  proportion  of  the  total  amount 
of  food  used,  their  omission  does  not  materially  condition  the  statement 
of  the  aggregate  amount  of  food  used  by  each  institution.  By  their  omis- 
sion in  the  tables  setting  forth  the  food  used  by  the  City  institutions  it  was 
possible  to  make  a  comparison  between  the  institutions  of  New  York  City 
and  the  State  institutions  in  the  three  States  indicated. 

Comparatively  little  attention  has  been  given  in  public  institutions,  here 
or  elsewhere,  to  methods  of  controlling  food  waste.  One  instance  of 
a  systematic  and  well-conceived  effort  along  this  line  occurred  in  connection 
with  the  State  Hospital  at  Kings  Park,  Long  Island.  At  the  suggestion  of 
your  Director  a  system  was  installed  at  that  institution  in  the  fall  of  1910, 

583 


584  HOSPITAL   COMMITTEE 

and,  with  some  modifications  and  enlargements,   has  been  in   successful 

operation  since  that  time.  It  has  produced  noteworthy  results  and  marked 
savings  to  the  institution,  accompanied  by  better  feeding  of  the  patients  and 
employees,  and  hearty  cooperation  on  the  part  of  employees  in  kitchens 
and  dining  rooms.  Inasmuch  as  practically  no  systematic  consideration 
of  food  waste  has  been  g^ven  in  the  institutions  of  New  York  City  it  has 
been  deemed  advisable  to  describe  the  method  and  results  in  Kings  Park 
State  Hospital  (page  603),  for  the  purpose  of  stimulating  similar  efforts 
in  our  municipal  institutions. 


THE  INVESTIGATION 

Bellevue  and  Allied  Hospitals 

The  food  used  in  the  Department  of  Bellevue  and  Allied  Hospitals  is 
purchased  by  the  General  Purchasing  Agent,  located  at  Bellevue,  and  all  of 
the  food  under  contract  is  delivered  to  the  storehouse  at  Bellevue,  from 
which  supplies  are  transferred  to  the  allied  hospitals.  This  includes  all 
food  used,  with  the  exception  of  fresh  fruits  and  fresh  vegetables.  Except 
for  local  conditions,  which  might  include  racial  preferences  or  prejudices 
for  or  against  certain  kinds  of  food,  it  might  be  assumed  that  the  propor- 
tions of  the  various  kinds  of  food  in  the  different  hospitals  of  the  Depart- 
ment of  Bellevue  would  be  practically  the  same.  This,  however,  is  not 
the  case. 

By  referring  to  the  tables  on  pages  612  to  615  it  will  be  observed  that 
of  meat  Bellevue  used  344.8  pounds  per  capita  per  year;  Harlem  372.5; 
Gouverneur  319.6;  and  Fordham  393.6.  As  a  detail  of  this,  it  will  be  no- 
ticed that  Fordham  Hospital  used  84.2  pounds  of  mutton  per  capita  per 
year,  whereas  Gouverneur  Hospital  used  but  44.1  pounds,  with  Harlem  Hos- 
pital following  midway  between  with  62.6  pounds  per  capita  per  year. 
Gouverneur  used  4.8  pounds  of  pork  per  capita,  as  compared  with  16.1 
pounds  used  by  Fordham,  and  about  11  pounds  each  for  Bellevue  and  Har- 
lem Hospitals.  This  smaller  amount  for  Gouverneur  Hospital  was  due  to 
the  predominance  of  patients  in  that  hospital  who  use  pork  in  very  limited- 
quantities.  This  being  so,  it  might  naturally  be  expected  that  Gouverneur 
would  use  a  larger  proportion  of  mutton  or  beef  than  the  other  hospitals, 
which,  however,  is  not  the  case. 

A  marked  difference  is  noted  in  connection  with  the  use  of  poultry. 
Bellevue  used  but  42  pounds  per  capita  per  year ;  whereas  Harlem  Hospital 
used  79.5  pounds ;  Gouverneur  47.5  pounds ;  and  Fordham  83.4  pounds.  A 
marked  difference  in  the  amount  of  milk  is  noticed,  namely:  Bellevue  used 
589  pounds  per  capita  per  year;  Harlem  Hospital  733  pounds;  Gouver- 
neur Hospital  658  pounds ;  and  Fordham  Hospital  but  547  pounds.  It 
might  be  supposed  that  the  hospital  that  used  the  least  milk  might  use  more 
eggs  as  a  substitute,  but  Fordham  Hospital,  showing  the  least  consumption 
of  milk  of  the  four  hospitals,  used  but  56  pounds  of  eggs,  whereas  Gouver- 
neur Hospital,  with  a  consumption  of  milk  of  658  pounds,  used  89  pounds 
of  eggs  per  capita  per  year. 

Not  only  did  the  items  of  food  vary  in  the  different  hospitals  of  the 
Department  of  Bellevue,  but  there  was,  as  a  result,  a  variation  in  the 
amounts  of  total  protein  and  calories  supplied  the  patients  and  employees. 
The  daily  per  capita  amount  of  protein  represented  in  the  food  furnished  to 
Bellevue  Hospital  was  122.3  grams,  and  of  calories  3,240  per  capita  per 
day;  in  Harlem  Hospital  126.8  grams  and  3,373  calories;  in  Gouverneur 
1 19.8  grams  and  2,959  calories;  in  Fordham  Hospital  124.6  grams  and 
3,356  calories.  It  will  be  noticed  that  Gouverneur  Hospital  was  somewhat 
behind  the  other  hospitals,  both  in  the  amount  of  protein  and  calories  sup- 
plied. 

585 


586  HOSPITAL   COMMITTEE 

Requisitions  for  Food  Supplies  from  the  Storehouse 

When  it  was  discovered  that  the  proportions  of  the  different  kinds  of 
food  in  the  alHed  hospitals  of  the  Department  of  Bellevue  varied  to  a  certain 
extent  an  investigation  was  made  to  determine  the  method  of  requisitioning 
by  the  allied  hospitals  from  the  main  storehouse  at  Bellevue.  It  was  found 
that  each  hospital  is  permitted  to  make  its  requisitions  without  any  state- 
ment having  been  issued  to  such  hospital  as  to  the  total  amount  of  food 
which  it  is  permitted  to  use  within  given  periods,  or  the  proportions  of  the 
total  amounts  which  it  would  be  expected  to  requisition.  When  the 
requisitions  reach  the  Dietitian  at  Bellevue  they  are  passed  upon  without 
any  knowledge  on  the  part  of  the  Dietitian  as  to  the  number  of  people  in 
the  hospital  making  the  requisition.  No  daily  or  weekly  census  is  fur- 
nished to  the  Dietitian,  and  the  Dietitian,  accordingly,  has  no  basis  on  which 
to  judge  the  adequacy  or  inadequacy  of  the  amount  of  food  requisitioned. 
Under  these  circumstances  it  is  surprising  that  the  per  capita  amounts  of 
different  kinds  of  food  varied  as  little  as  indicated  by  the  tables  referred  to. 

Meats  are  contracted  for  quarterly  by  the  Contract  Clerk  at  Bellevue. 
The  estimate  of  the  amount  needed  is  not  based  upon  any  data  furnished 
by  the  Dietitian,  and  the  Dietitian  is  not  consulted  by  the  purchasing  de- 
partment with  regard  to  the  total  quantity  or  the  proportions  of  food  re- 
quired, as  the  estimate  is  made  in  the  accounting  department  and  is  based 
upon  the  amount  of  food  used  in  previous  periods.  In  other  words,  the 
accounting  department  is  interested  in  the  determination  of  the  amount  and 
kinds  of  food  used,  and  the  Dietitian,  who  is  primarily  interested  in  the 
feeding  of  the  patients,  has  no  part  in  such  determination. 

Contracts  made  for  State  institutions  provide  that  the  institutions  may 
order  "more  or  less,  or,  as  may  be  required  for  the  use  of  the  institutions 
for  the  time  specified."  This  provision  enables  the  institutions  to  vary  the 
amount  actually  purchased,  according  to  the  fiuctuation  of  the  census.  The 
contracts  entered  into  by  Bellevue  may  reduce  the  contract  amount  by  5  per 
cent.,  but  may  not  increase  it.  As  a  result  of  this  narrow  margin,  or  lee- 
way, Bellevue  has  purchased  practically  the  total  amount  of  its  various  con- 
tracts for  food. 

Requisitions  Not  Based  upon  the  Census 

Requisitions  for  food  supplies  are  made  out  by  the  Dietitian,  approved 
by  the  Assistant  Superintendent,  and  filed  by  the  Storekeeper.  These  re- 
quisitions are  not  based  upon  the  census  day  by  day;  nor,  apparently,  are 
they  based  upon  the  change  of  the  census  month  by  month,  or  season  by 
season. 

During  the  first  half  of  1912,  ended  June  30,  the  average  weekly  use 
of  meat  and  fish  for  the  patients  alone  amounted  to  4,671  pounds.  During 
this  period  the  average  daily  census  of  patients  was  1,324.  During  the 
second  half  year,  ended  December  29,  1912,  the  average  weekly  delivery 
was  4,733  pounds,  while  the  average  daily  census  was  1,171.  Thus,  it  will 
be  noticed  that  more  meat  was  used  in  the  gross  when  the  average  census 
was  1,171  than  during  the  first  half  of  the  year,  when  it  was  1,324.  The 
highest  daily  average  census  was  during  the  week  ended  April  28,  1912. 
The  average  daily  amount  of  meat  per  patient  served  during  that  week  was 
.48  pound.  If  it  be  assumed  that  the  patients  were  well  and  sufficiently  fed 
on  the  allowance  provided  for  that  week,  and  this  same  ratio  were 
applied  throughout  the  year,  Bellevue  would  have  used  217,774  pounds  of 


FOOD   AND   FOOD    WASTE  587 

meat  and  fish  for  the  patients,  instead  of  244,289  pounds,  which  were  actu- 
ally used.  Thus,  there  were  served  to  the  patients  26,515  pounds  of  meat 
and  fish  more  than  would  have  been  served  if  the  ratio  used  in  the  week 
ended  April  28  had  been  maintained ;  which  was  approximately  the  same 
ratio  as  was  maintained  for  the  months  of  March,  April,  and  May. 

The  failure  to  adjust  the  requisitions  to  the  shifting  census  was  noted 
in  connection  with  the  use  of  eggs,  as  well  as  in  connection  with  meat.  Dur- 
ing the  months  of  March,  April,  and  May,  1912,  Bellevue  requisitioned  and 
used  an  average  of  9,708  dozen  eggs  per  month.  ,  In  these  months  the 
average  daily  census  of  patients  was  1,337.  During  August,  September, 
and  October  an  average  of  9,740  dozen  eggs  were  used  monthly.  The 
average  daily  census  of  patients  in  this  period  was  1,159.  Thus,  it  will  be 
noticed  that  more  eggs  in  the  gross  were  used  for  1,159  patients  than  for 

1.337- 

During  the  year  1912  Bellevue  used  94,926  pounds  of  fowl.  The  pa- 
tients daily,  for  6  days  in  the  week,  received  100  pounds  of  fowl.  On  the 
seventh  day  120  pounds  were  requisitioned.  At  this  rate  there  were 
approximately  37,540  pounds  used  by  the  patients  during  the  year.  The 
rest  of  the  fowl  purchased,  namely,  57,386  pounds,  was  used  by  the  officers 
and  employees.  Since  about  350  hospital  helpers  received  almost  no  fowl, 
except  at  holiday  seasons,  about  675  officers  and  employees  used  nearly 
20,000  pounds  more  than  the  1,243  patients. 

A  similar  failure  to  adjust  the  requisitions  to  the  fluctuating  census  was 
noted  in  connection  with  several  other  articles  of  food  used. 

Bellevue  used  771,075  pounds  of  meat  and  fish  during  the  year  1912. 
This  was  for  both  patients  and  employees.  Had  the  patients  been  served 
a  half  pound  per  capita  per  day,  which  is  a  greater  ratio  than  that 
actually  used  during  several  months  of  the  year,  and  had  the  employees  re- 
ceived a  pound  per  capita  per  day,  the  total  consumption  by  the  Hospital 
would  have  been  596,582  pounds.  The  ratio  of  i  pound  per  day  for 
employees  is  not  only  ample,  but  a  heavier  meat  diet  than  seems  advisable. 
However,  had  this  ratio  been  maintained,  Bellevue  would  have  saved  about 
$20,900  in  meat  and  fish  alone,  estimating  the  cost  of  the  different  kinds  of 
meat  at  an  average  of  12  cents  per  pound. 

Food  Waste 

Inasmuch  as  the  amount  of  meat  actually  used  seemed  somewhat  exces- 
sive, it  was  deemed  advisable  to  make  a  detailed  examination  of  the  amount 
of  meat  used  and  the  method  of  handling  it  in  several  of  the  kitchens  and 
dining  rooms  of  the  hospital.  For  this  purpose  the  staff  dining  room,  the 
orderlies'  dining  room,  and  the  dining  rooms  in  the  School  for  Attendants 
and  in  the  Nurses'  Residence  were  selected.  The  employees  of  these  dining 
rooms  were  asked  to  weigh  for  a  period  of  i  week  the  total  amount  of 
food  returned  from,  or  prepared  and  not  served  on,  the  plates.  The 
amounts  reported  from  these  dining  rooms  are  set  forth  in  the  following 
table : 


588  HOSPITAL  COMMITTEE 

Waste  Food  in  Bellevub  Hospital. 

Showing  the  Gross  Pounds  of  Food  Served  in  Dining  Rooms  and  Relumed  on  Plates,  upon  the 
Days  Indicated,  in  June,  iqiz. 

Staff                             Nurses'                           School  Orderlies' 

Dining  Room                 Residence                  for  Attendants  Dining  Room 

Weights  determined     Weights  determined     Weights  determined  Weights  determined 

by  the                           by  the                            by  the  by  the 

Pupil  Dietitian               Housekeeper                 Housekeeper  Chef 


Average  Number  served: 

Breakfast. 

178 

348 

Luncheon . 

238 

359 

80 

360 

Dinner .  .  . 

188 

348 

Day       Meal 

Lbs. 

Day 

Meal 

Lbs. 

Day 

Meal 

Lbs. 

Day 

Meal 

Lbs. 

7             B 

135 

4 

B 

109 

6 

B 

6 

3 

B 

28 

L 

126 

L 

129 

L 

11 

D 

45 

Dog  meat 

3 

D 

D 

128 

D 

25 

S 

58 

9             B 

104 

5 

B 

96 

7 

B 

9 

4 

B 

139 

Dog  meat 

36 

L 

128 

L 

117 

L 

12 

D 

65 

D 

D 

131 

D 

22 

S 

78 

10            B 

6 

B 

109 

8 

B 

11 

5 

B 

50 

L 

114 

L 

127 

L 

11 

D 

79 

Bones  for  dogs 

21 

D 

134 

D 

137 

D 

12 

S 

44 

11            B 

110 

9 

B 

56 

9 

B 

4 

6 

B 

70 

Bones  for  dogs 

19 

L 

103 

L 

73 

L 

14 

D 

84 

Bones  for  dogs 

32 

D 

D 

141 

D 

S 

49 

12            B 

128 

10 

B 

129 

10 

B 

7 

7 

B 

43 

L 

191 

L 

81 

L 

D 

54 

D 

D 

123 

D 

28 

S 

27 

13            B 

143 

11 

B 

129 

11 

B 

8 

8 

B 

58 

L 

94 

L 

116 

L 

9 

D 

49 

Bones  for  dogs 

14 

D 

D 

131 

D 

14 

S 

42 

14            B 

141 

12 

B 

133 

12 

B 

6 

9 

B 

46 

Bones  for  dogs 

14 

L 

171 

L 

125 

L 

7 

D 

46 

Bones  for  dogs 

20 

D 

D 

137 

D 

19 

S 

50 

Total J 

1,981 

2,457 

235 

1,204 

Lbs.  per  day 

269 

351 

34 

172 

Per    capita    lbs. 

per  day 

1.4 

1 

.42 

.48 

FOOD   AND   FOOD    WASTE  589 

It  will  be  noticed  in  the  foregoing  table  in  connection  with  the  staff  din- 
ing room  that  261  pounds  of  food  were  returned  from  the  plates  on  June 
7,  1913;  232  pounds  were  returned  on  June  9;  and  237  pounds  on  June  13. 
The  total  waste  food  returned  from  the  plates  in  this  dining  room  during 
the  7  days  amounted  to  1,981  pounds. 

It  will  be  observed  that  on  most  days  there  was  an  item  named  "Dog 
meat,"  or,  "Bones  for  dogs."  The  aggregate  amount  of  this  food  in  the  7 
days  was  159  pounds.  This  would  feed  many  more  dogs  than  were  found 
about  the  grounds  of  Bellevue.^ 

In  the  orderlies'  dining  room  the  waste  food  returned  from  the  plates  on 
June  3  amounted  to  131  pounds;  on  June  4,  282  pounds;  on  June  5,  173 
pounds.  The  total  amount  of  waste  food  returned  from  the  plates  during 
the  7  days  of  record  amounted  to  1,204  pounds. 

The  waste  on  plates  in  the  dining  room  of  the  School  for  Attendants 
on  June  6  was  42  pounds,  and  on  June  7  it  was  43  pounds.  The  total  amount 
returned  from  the  plates  during  the  7  days  in  which  the  waste  was  noted 
was  235  pounds. 

The  plate  waste  in  the  dining  room  of  the  Nurses'  Residence  on  June 
4  was  366  pounds,  and  on  June  6  it  was  373  pounds.  The  total  plate  waste 
during  the  7  days  in  which  the  record  was  kept  amounted  to  2,457  pounds. 

The  average  per  capita  waste  of  food  in  these  dining  rooms  compared 
with  the  same  kind  of  waste  in  the  State  Hospital  at  Kings  Park  is  set 
forth  in  the  following  table: 

Food  Waste  in  Bellevue  Hospital  as  Compared  with  Similar  Waste  in  Kings  Park 

State  Hospital. 

The  Figures  Represent  Only  the  Waste  Food  Returned  from  the  Plates. 

Kings  Park,  July  to  Dec,  1912.        Bellevue,  June  6-12, 1913. 


J3 

a 

P3 

Q 

<J 

0 

-S       ^         <M       CO      -g  0)      g  §    .9       -    g  ;S_'a«' 

g        g      §     -^  §    I  g'  o  §   SS  E^l  3  g 

!S     6    6    £^   ^-a  ^p^  ^1  a^^< 

S  02  ■§ 


Average  census  per  meal..     985     9231,450    659    394   4,411     360    201     351       80    992 
Per  capita  daily  waste — 

pounds 33     .19     .17     .22     .33     .23     .48      1.4     1.0     .42     .84 

According  to  the  above  table  the  lowest  per  capita  waste  in  Bellevue  was 
in  the  dining  room  of  the  School  for  Attendants.  This  was  .42  pound  per 
capita,  per  day,  whereas  the  lowest  waste  noted  in  Kings  Park  State  Hospi- 
tal was  .17  pound.  The  highest  per  capita  waste  in  Bellevue  was  in  connec- 
tion with  the  staff  dining  room,  where  it  amounted  to  1.4  pounds  per  capita 
per  day,  whereas  in  Kings  Park  State  Hospital  the  highest  per  capita  daily 
waste  was  .33  pound.  The  average  waste  in  the  dining  rooms  at  Bellevue 
was  .84  pound  per  capita  per  day,  whereas  in  Kings  Park  State  Hospital 
it  was  but  .23  pound. 

'  Since  this  observation  was  made  measures  have  been  taken  to  regulate  and 
account  for  meat  used  as  forage. 


590  HOSPITAL   COMMITTEE 

The  marked  difference  in  waste  in  Bellevr.e  as  compared  with  Kings 
Park  prompted  a  closer  and  more  detailed  investigation  in  the  former.  For 
this  purpose  the  staff  dining  room  and  the  dining  room  in  the  Nurses'  Resi- 
dence were  selected.  An  investigator  from  the  Committee,  Air.  Frank  E. 
Brooke,  separated  the  waste  from  the  plates  as  they  came  from  the  dining 
room  during  each  meal  for  a  period  of  6  days.  This  close  segregation  of 
the  waste  was  made  for  the  purpose  of  determining  the  chief  elements  en- 
tering into  the  waste.  The  dietitians  having  supervision  of  each  of  these 
dining  rooms  questioned  somewhat  the  feasibility  of  making  such  a  separa- 
tion during  the  process  of  serving  the  meals  and  washing  the  dishes,  fear- 
ing that  it  would  confuse  the  work  and  add  to  the  labor  of  the  employees. 
They,  however,  consented  to  allow  the  investigator  to  undertake  the  work, 
and,  when  it  had  progressed  but  a  short  time,  it  became  evident  that  the 
separation  of  waste  into  classes  not  only  did  not  interfere  with  the  ordinary 
operations  of  the  dining  room  and  pantry,  but  added  to  the  facility  and 
speed  with  which  they  were  carried  on.  It  was  conclusively  demonstrated 
that  it  is  practicable  to  perform  such  work  daily,  and  in  connection  with 
each  meal. 

According  to  the  separation,  recorded  in  the  accompanying  tables,  the 
food  that  was  returned  on  the  plates  was  considered  unusable  and  entered 
as  one  class;  and  the  food  that  remained  in  the  pantry  and  had  not  been 
served  on  the  plates  was  recorded  as  another  class.  In  explanation  of 
the  table  it  should  be  stated  that  it  was  assumed  that,  as  the  food  listed  as 
remaining  in  the  pantry  was  in  a  large  measure  usable,  it  very  likely  was 
served  in  some  form  at  a  subsequent  meal,  and,  therefore,  does  not  enter 
into  the  figures  of  waste. 

By  comparing  the  results  of  the  investigator's  weighing  of  waste  with 
that  of  the  employees  of  the  dining  rooms,  which  is  shown  in  the  table  on 
page  588,  it  will  be  seen  that  the  waste  from  the  plates  in  the  stafif  dining 
room  amounted  to  1,190  pounds  during  the  6  days  in  July  in  which  the 
experiment  was  carried  on,  and  in  a  like  period  of  6  days  in  June  in  which 
the  employees  weighed  the  waste  it  amounted  to  1,712  pounds.  In  the 
Nurses'  Residence  dining  room  the  investigator  recorded  1,361  pounds, 
whereas  the  employees  reported  2,106  pounds.  The  lesser  amount  of  waste 
noted  by  the  investigator  may  have  been  partly  due  to  the  fact  that  the 
dining  rooms  had  been  experimenting  on  cutting  down  the  waste  during  the 
period  from  June  5  to  the  latter  part  of  July,  when  the  investigator  made 
his  experiment,  and  it  may  also  be  explained  by  the  supposition  that  the  em- 
ployees, in  their  experiment,  may  have  included  certain  elements  of  non- 
usable  food  which  were  excluded  by  the  investigator.  The  latter  excluded 
all  liquids,  but  some  may  have  been  included  in  the  experiment  carried  on 
by  the  employees. 

A  detailed  examination  of  the  following  table  will  show  marked  waste 
of  certain  articles  of  food.  For  instance,  on  July  19  40  pounds  of  lamb 
chops  served  at  lunch  were  returned  from  the  plates.  It  is  probable  that 
a  large  percentage  of  this  amount  was  bone,  but  the  investigator  reported 
verbally  that  a  good  proportion  of  it  was  composed  of  chops  which  had 
not  been  touched,  or  had  been  only  partially  eaten.  On  July  21  25  pounds 
of  porterhouse  steak  were  returned  from  lunch.  This  was  all  edible  meat. 
At  the  same  meal  38  pounds  of  porterhouse  steak  remained  in  the  pantry 
unserved.  On  July  22  35  pounds  of  liver  and  veal  cutlets  were  returned 
from  lunch,  and  from  evening  dinner  25  pounds  of  roast  beef  and  chicken 


FOOD   AND   FOOD    WASTE 


591 


FOOD  WASTE. 

Staff  Dining  Room — Bellevue  Hospital. 

Analysis  of  Waste  and  Usable  Food  Returned  from  Dining  Room  to  Pantry  during  6  Days  Ended  Friday, 

July  25,  IQI3- 

Pounds  of  Usable    Food 
Left  Over,  Not  Served  to 
Pounds  of  Waste  Food  Returned  from  Plates.  Dining  Room, 


&    1                 3 

1 

1 

1 

¥ 

is 

Q 

July  18  L   Fish  and  Steak 

D  Fish  and  Roast  Beef. 

July  19  B   Bacon  and  Eggs 

4 

1 

8 

1 

2 

7 

3 

11 

8 
10 

6 

Pie 

Pie 

Cantaloup 
Rinds 

7 
8 

62 

K"     2 


July  21 


17      22       12 


43      10      12 


July  22 

July  23 
July  24 


B    Bacon  and  Eggs. 

L  Steak 

D  Roast  Beef 


B    Bacon  and  Eggs 

L   Hamburg  Steak  and 

Ham 

D  Veal  and  Corned  Beef 


Cantaloup 

Rinds 70 

Pie  4 


2 

40 

11  . 

'•Jr 

27 

11 

9 

6 

2 

2B 

10 

3     ... 

July  25  B   Bacon  and  Eggs. . . 

7 

6 

3      24 

5     .... 

Totals 

.     238 

58 

19    233 

113 

471         58    311 

85 

21 

4 

Total 

1,190 

421 

Average  daily  waste 198 

Average  daily  waste  per  capita  (average  daily  census  202) 98 

were  returned.  At  the  same  time  there  remained  in  the  pantry,  unserved, 
40  pounds  of  roast  beef  and  chicken.  On  July  23  18  pounds  of  steak  were 
returned  from  lunch,  and  46  pounds  remained  in  the  pantry  unserved. 

On  July  21  9  pounds  of  bacon  and  eggs  were  returned  from  breakfast, 
but  this  included  a  small  amount  of  toast.  The  actual  number  of  eggs 
wasted  was  not  determined,  but,  according  to  the  weights,  and  the  propor- 
tion of  bacon,  toast,  and  eggs  reported  by  the  investigator,  it  is  probable 
that  not  less  than  6  pounds  of  this  total  weight  consisted  of  eggs,  which 
would  represent  not  less  than  4  dozen  eggs.  Nearly  as  high  a  ratio 
of  waste  was  noted  in  connection  with  each  breakfast,  which  in  all  cases  was 
composed  of  bacon  and  eggs. 

It  will  be  noticed  that  salad  was  served  in  connection  with  most  of  the 
meals,  and  that  the  waste  was  large.  For  instance,  on  July  22  23  pounds 
of  salad  were  returned  from  breakfast,  and  13  pounds  from  lunch.  On 
July  23  27  pounds  of  salad  were  returned  from  the  plates  at  breakfast,  and 
22  pounds  from  lunch.    The  salad  served  was  composed  largely  of  lettuce. 


592 


HOSPITAL  COMMITTEE 


In  this  waste,  however,  was  included  lemon  peels,  and  many  unused  pieces 
of  lemon.  It  is  the  custom  to  serve  lemons  for  use  on  salads,  in  lemonade, 
and  tea.  A  large  percentage  of  these  lemons  were  returned  to  the  pantry, 
either  unused  or  but  partially  used. 

It  will  be  noticed  in  the  column  headed  "Dessert"  that  cantaloup  was 
served  at  4  meals  during  the  6  days,  and  also  that  the  waste  was  heavy. 
The  average  waste,  which  included  uneaten  portions  as  well  as  rinds, 
amounted  to  82  pounds. 

In  the  same  class  of  food  the  waste  of  pie  was  also  found  to  be  large. 
On  July  18  7  pounds  of  pie  were  returned  on  the  plates;  8  pounds  on  July 
21 ;  and  10  pounds  on  July  22.  This  indicates  that,  on  an  average,  fully  8 
pounds  of  pie  were  returned  from  the  plates  each  time  it  was  served. 

The  average  daily  waste  of  food  returned  from  the  plates  was  198 
pounds,  or  .9  pound  per  capita  per  day.  As  previously  stated,  the  high- 
est per  capita  waste  noted  in  connection  with  Kings  Park  Hospital  was  .33 
pound,  and  the  lowest  .17  pound. 

The  following  table  sets  forth  the  results  of  the  examination  of  the 
waste  made  by  the  investigator  in  the  dining  room  of  the  Nurses'  Residence, 
in  which  an  average  of  about  350  people  are  served  at  each  meal.  The  ex- 
amination was  made  in  the  same  manner  as  that  in  the  staff  dining  room. 

FOOD  WASTE. 

Dining  Room  in  Nurses'  Residence — Bellevue  Hospital. 

Analysis  of  Waste  and  Usable  Food  Returned  from  Dining  Room  to  Pantry  during  6  Days  Ended 

August  4,  IQ13. 

Pounds  of  UsableFood  Left 

Over,  Not  Served  to  Dining 

Room 


'if 


July  29       B 


Boiled  Eggs. 

Steak 

Chicken 


July  30       B       Boiled  Eggs 

L        Corned  Beef  Hash. 
D       Roast  Lamb 


July  31       B 


Boiled  Eggs 

Liver  and  Bacon. 
Roast  Beef 


Boiled  Eggs. 

Fish 

Fish 


Aug.  2  B  Boiled  Eggs. 
L  Irish  Stew . . . 
D       Veal 


Boiled  Eggs.. 

Steak 

Roast  Lamb. 


"s     '.'.'.     '.'.'. 

ii    '.'.'.    'ii 

"5    "5    '.'.'. 
15      11       6 

'25     '.'.'.     '.'.'. 
9     ... 

'is    'io    '.'.'. 

6     ... 
11       16     ... 

26    '.'.'. 

'.'.    "0 

Total 

285 

71 

139 

189 

677 

98 

57 

20 

20 

9 

Total 

1,361 

20« 

Daily  waste ..__.._ 

Daily  waste  per  capita  (average  daily  census  about  350) . 


FOOD   AND   FOOD    WASTE  593 

It  will  be  observed  by  examining  the  foregoing  table,  that  there  was  a 
heavy  waste  of  meat  returned  from  the  plates.  On  July  29  38  pounds  of 
steak  were  returned  from  lunch  and  51  pounds  of  chicken  from  dinner. 
However,  not  all  of  this  large  amount  of  chicken  waste  was  returned  from 
the  plates,  but  a  portion  of  it  had  remained  in  the  pantry,  unserved,  and 
while  hot  was  placed  in  the  icebox,  with  the  intention  of  serving  it  the 
following  day  to  the  help,  but,  because  of  its  condition  when  placed  in 
the  icebox,  it  spoiled. 

On  August  2  39  pounds  of  Irish  stew  were  returned  from  the  plates  and 
put  into  the  garbage,  and  56  pounds  of  veal  were  returned  from  dinner, 
while  on  August  4  28  pounds  of  steak  were  returned  from  the  lunch  plates. 

It  will  be  noticed  that  there  was  a  heavy  waste  of  cereal.  On  July  29 
20  pounds  were  returned  from  breakfast ;  on  July  30  38  pounds ;  on  July 
31  30  pounds;  on  August  i  27  pounds;  and  on  August  2  15  pounds.  The 
total  waste  of  cereal  for  the  6  days  was  139  pounds,  or  about  .4  pound  per 
capita.  The  total  waste  of  cereal  in  the  staff  dining  room  for  6  days  was 
but  19  pounds,  or,  .09  pound  per  capita.  The  excessive  waste  of  cereal  in 
the  Nurses'  Residence,  as  compared  with  the  staff  dining  room,  is  probably 
due  to  the  difference  in  the  method  of  serving,  and  the  kinds  of  cereal 
used.  In  the  staff'  dining  room  the  cereal  is  served  from  the  pantry  in 
individual  dishes,  whereas  in  the  nurses'  dining  room  the  cereal  is  served 
from  a  tureen  placed  on  each  table.  The  staff  dining  room  gives  a  choice 
of  several  kinds  of  cereal,  whereas  but  one  kind  is  served  in  the  nurses' 
dining  room. 

It  will  be  observed  that  under  the  head  of  "Plate  scraps"  there  was  a 
total  of  6yy  pounds  of  waste  during  the  6  days.  These  scraps  were  com- 
posed of  various  articles  of  food  that  were  mixed  together  on  the  plates, 
and  could  not  be  readily  separated.  At  breakfast,  for  instance,  the  eggs 
were  served  in  the  shell,  and  not  infrequently  when  unused  were  broken 
and  mixed  into  various  foods  upon  the  plates.  A  salad  at  lunch  was 
served,  and  when  it  was  returned  to  the  pantry  it  had  been  mixed  with 
other  waste  food  on  the  plates.  The  chief  element  of  waste  at  dinner  was 
vegetables ;  at  lunch  it  was  vegetables  and  salad. 

The  daily  waste  of  all  food  served  in  this  dining  room  during  these 
6  days  amounted  to  281  pounds,  and  the  daily  per  capita  waste  was  .8 
pound. 

It  is  notable  that  the  amount  of  food  left  in  the  pantry  not  served  on 
the  plates  amounted  to  204  pounds  in  the  nurses'  dining  room,  and  421 
pounds  in  the  staff  dining  room.  It  is  evident  that  the  nurses'  dining  room 
adjusts  the  amount  of  food  much  more  closely  to  the  needs  of  the  persons 
served  than  does  the  staff  dining  room. 

During  the  week  ended  July  22  the  staff  dining  room  requisitioned  and 
received  2,576  pounds  of  meat,  which  provided  for  1.8  pounds  per  capita 
per  day.  The  nurses'  dining  room  requisitioned  and  received  during  the 
week  ended  August  3  3,076  pounds  of  meat,  which  provided  1.26  pounds 
per  capita  per  day.  Such  per  capita  portions  are  much  larger  than  the 
portions  provided  in  most  private  families. 

The  use  of  such  an  excessive  amount  of  meat  was  doubtless  due,  in  a 
measure,  to  the  method  of  serving.  In  the  staff  dining  room  each  indi- 
vidual was  served  with  a  piece  of  steak  from  4  to  5  inches  in  diameter 
and  more  than  an  inch  in  thickness,  and  hamburger  steak  was  made  in 
patties  fully  4  inches  in  diameter  and  more  than  an  inch  thick.  These  large 
individual  portions  were  served  on  the  plates  in  the  pantry,  and,  as  a  result 


594  HOSPITAL   COMMITTEE 

of  such  over-generous  service,  much  meat  was  returned  uneaten,  and, 
in  many  cases,  more  was  eaten  than  is  probably  conducive  to  health. 

Because  of  this  method  of  serving  meat  the  Dietitian  was  requested, 
through  the  Superintendent  of  the  Hospital,  to  serve  meat  in  much  smaller 
portions,  and,  so  far  as  possible,  to  place  a  platter  of  meat  upon  each  table 
and  allow  a  second  Helping  when  desired.  An  experiment  in  this  method 
of  serving  was  instituted  in  two  dining  rooms  the  last  week  in  August. 

Much  to  the  credit  of  the  dietary  department  this  experiment  was  car- 
ried out  thoroughly  and  in  good  faith.  The  Committee  checked  the  results 
of  the  work  for  the  week  ended  October  13,  1913,  and  compared  it  with 
the  corresponding  week  of  1912.  During  the  week  ended  October  12,  1912, 
Bellevue  and  its  allied  hospitals  consumed  of  meat  and  fish  20,597  pounds. 
During  the  week  ended  October  13,  1913,  the  consumption  was  17,300 
pounds,  a  saving  of  3,297  pounds.  The  census  for  the  week  in  1913  was 
nearly  200  higher  than  for  the  week  in  1912.  Thus,  a  larger  number  of 
patients  was  fed  with  17,300  pounds  in  1913  than  with  20,597  pounds  in 
1912.  This  amount  of  saving  for  i  week  represents  an  estimated  aggre- 
gate saving  for  a  year  of  171,444  pounds,  the  value  of  which,  at  12  cents  a 
pound,  would  be  $20,573. 

The  experiment,  up  to  the  time  of  publishing  the  Report,  had  not  been 
extended  to  articles  of  food  other  than  meat,  but  it  is  fair  to  assume  that 
when  the  full  waste  system  suggested  in  this  Report  is  put  into  operation 
the  aggregate  saving  on  food  in  the  Department  of  Bellevue  and  Allied  Hos- 
pitals will  probably  be  not  less  than  $30,000  annually. 

Department  of  Public  Charities 
Food  Accounting 

The  General  Storehouse  on  Blackwell's  Island  is  used  as  a  distributing 
point  for  supplies  to  institutions  located  in  Manhattan  and  the  Bronx.  In- 
stitutions draw  on  this  Storehouse  for  perishable  foods,  produce,  etc., 
weekly,  and  all  other  supplies  monthly.  The  one-story  buildings  used  as  the 
General  Storehouse  on  Blackwell's  Island  were  built  in  the  sixties,  and  are 
now  too  small.  Crockery  and  chinaware  are  kept  in  a  separate  building  on 
the  east  side  of  the  Island. 

The  present  system  of  accounting  in  operation  at  the  General  Storehouse 
is  cumbersome,  and  involves  needless  repetitions  of  entries.  Three  ledgers 
are  kept :  one  for  food  supplies ;  one  for  all  other  supplies ;  and  one  for 
contracts.  A  ledger  for  contracts  is  also  kept  at  26th  Street.  The  articles 
are  shown  both  in  quantity  and  amount;  and  all  supplies  are  billed  to  the 
institutions,  both  in  quantity  and  amount ;  and  the  institutions,  in  turn,  enter 
them  on  their  books  in  like  manner. 

The  showing  of  all  items  in  dollars  and  cents  on  a  storekeeper's  records 
is  superfluous,  as  the  Central  Ofifice  keeps  records  that  contain  this  in- 
formation. 

The  distribution  of  supplies  for  Brooklyn  and  Queens  is  made  in  a 
dififerent  manner  from  that  m  use  in  Manhattan  and  The  Bronx. 

For  the  former  division  there  is  but  one  storehouse,  from  which  all 
supplies  are  issued  daily  to  Kings  County  Hospital  and  the  Home  for  the 
Aged  and  Infirm,  and  three  times  a  week  to  the  other  three  institutions  in 
Brooklyn,  viz. :  Reception  Hospital,  at  Coney  Island ;  Cumberland  Street 
Hospital;  and  Bradford  Street  Hospital. 


FOOD   AND  FOOD    WASTE  595 

The  records  of  supplies,  as  well  as  payrolls,  for  all  institutions  are  kept 
at  this  storehouse,  and,  so  far  as  can  be  judged  from  the  consumption  of 
supplies,  the  centralization  of  control  as  adopted  in  Brooklyn  and  Queens 
has  resulted  in  greater  efficiency  and  economy  than  in  the  other  two  divi- 
sions. 

Special  attention  was  given  to  the  method  of  accounting  for  meat  sup- 
plied. 

Meat  is  sent  direct  from  26th  Street  to  the  institutions  on  Blackwell's 
and  Randall's  Islands,  and  does  not  pass  through  the  General  Storehouse. 
An  examination  was  made  of  the  accounting  for  such  meat  at  Metropolitan 
and  City  Hospitals.  The  total  amount  of  meat  sent  to  these  Hospitals  was 
noted  from  the  General  Storehouse  books,  and  the  amount  ordered  by  the 
Dietitians  to  be  delivered  by  the  butcher  to  the  kitchens  was  compiled  from 
the  daily  order  slips  of  the  Dietitians.  According  to  the  General  Storehouse 
records,  Metropolitan  Hospital  received  during  the  fiscal  year  which  began 
January  i,  191 1,  431,000  pounds  of  beef.  The  Dietitian's  records  showed 
that  311,000  pounds  were  requisitioned  from  the  butcher,  and  presumably 
were  delivered  to  the  kitchens.  This  difference  in  the  gross  amount  re- 
ceived by  the  institutions  and  the  net  amount  delivered  to  the  kitchens,  120,- 
000  pounds,  was  a  shrinkage  or  waste  of  27  per  cent.  It  was  stated  by  the 
Dietitians  that  not  infrequently  the  butcher  would  deliver  beef  to  the 
kitchens  on  a  requisition  for  mutton  or  veal,  and  possibly  a  portion  of  this 
shrinkage  or  waste  was  accounted  for  by  that  fact.  No  record,  however, 
was  kept  of  such  substitution,  and  it  was  impossible  to  determine  to  what 
extent  it  had  taken  place. 

In  Brooklyn  the  storehouse  at  Kings  County  Hospital  receives  and  dis- 
tributes the  meat  for  Kings  County  Hospital,  the  Home  for  the  Aged  and 
Infirm,  Coney  Island  Hospital,  Cumberland  Street  Hospital,  and  Bradford 
Street  Hospital.  As  heretofore  stated,  delivery  is  made  daily  to  Kings 
County  Hospital  and  to  the  Home,  and  tri-weekly  to  the  other  institutions. 
The  butcher  delivers  to  the  institutions  on  requisitions  from  the  Dietitians, 
and,  in  the  case  of  Kings  County  Hospital,  the  actual  weights  received  are 
checked  against  such  requisitions  by  the  Dietitian's  assistant.  In  this  store- 
house the  butcher  keeps  a  record  of  the  amount  of  meat  distributed,  which 
record  was  checked  by  your  examiners  against  the  records  of  the  meat  actu- 
ally received  by  the  Dietitian.  As  an  illustration  of  the  extent  to  which  these 
two  records  disagree,  the  deliveries  for  the  first  week  in  January,  1912,  show 
the  following  discrepancies: 

According  to  the  records  of  the  Dietitian,  Kings  County  Hospital  re- 
ceived 2,452  pounds  of  beef,  and  970  pounds  of  bone  and  stock,  making  a 
total  of  3,422  pounds.  The  butcher  charged  the  Hospital  with  1,739 
pounds  of  fores  and  2,312  pounds  of  hinds,  or  a  total  of  4,051  pounds, 
which  made  a  difference  in  the  records  of  629  pounds,  or  a  variation  of 
15.5  per  cent.  The  butcher,  at  the  same  time,  was  delivering  beef  to  the 
Home  for  the  Aged  and  Infirm,  without  keeping  an  account  of  such  de- 
liveries. Whether  or  not,  through  error,  he  charged  Kings  County  Hos- 
pital with  some  meat  delivered  to  the  Home,  it  was  impossible  to  determine. 

To  ascertain  what  should  be  the  normal,  or  visual,  amount  of  shrinkage 
and  waste  between  the  gross  amount  received  by  the  butcher  and  the  net 
amount  delivered  to  the  kitchens,  inquiry  was  sent  to  several  of  the  New 
York  State  Hospitals  for  the  purpose  of  learning  what  had  occurred  in 
those  institutions  with  regard  to  this  matter.  To  such  inquiries  the  follow- 
ing replies  were  received : 


596  HOSPITAL   COMMITTEE 

Manhattan  State  Hospital,  Ward's  Island,  Sept.  24,  i<)i2. 
The  loss  between  the  gross  weight  of  beef  received  by  the  butcher  and  the  net 
amount  distributed  to  the  kitchen  is  approximately  2  per  cent,  which  is  accounted 
for  by  the  suet  fat  being  cut  off,  the  chips  from  bones,  and  the  loss  from  cutting, 
etc. 

Central  Islip  State  Hospital,  Oct.  I,  i<)i2. 
The  difference  between  the  gross  weight  of  beef  received  by  our  butcher  and 
net  amounts  distributed  to  the  kitchens  is  an  average  of  about  i  per  cent,  in  waste 
and  shrinkage. 

Hudson  River  State  Hospital,  Poughkeepsie,  Oct.  iS,  1912. 
The  shrinkage  in  beef  at  this  hospital  is  practically  nil.     This  is  accounted  for 
by  the  fact  that  we  are  fortunate  in  having  our  present  deliveries  made  two  or  three 
times  weekly  from  local  coolers  in  the  city.    In  this  way,  the  meat  is  in  our  coolers 
but  a  short  time  before  it  is  cut  up  and  issued. 

It  will  be  observed  from  the  above  letters  that  no  institution  reported  a 
shrinkage  of  more  than  2  per  cent.  This  shrinkage  in  the  State  institutions 
evidently  consisted  of  the  natural  evaporation  of  the  meat  due  to  storage, 
and  also  the  scrap  waste  due  to  cutting  the  meat;  and  inasmuch  as  practi- 
cally all  bone  and  fat  should  be  sent  to  the  kitchens  as  partly  edible,  these 
percentages  given  should  cover  any  and  all  loss  shown  by  the  records. 

By  experiments  carried  on  at  Rochester  State  Hospital  it  has  been  de- 
termined that  the  total  bone  of  the  average  carcass  is  approximately  19  per 
cent,  of  the  total  weight  of  the  carcass.  By  careful  records  kept  during 
the  month  of  October,  1912,  at  Hudson  River  State  Hospital  it  was  found 
that  the  butcher  sent  to  the  kitchens  in  the  form  of  bone-cuttings  and  fat 
about  15  per  cent,  of  the  total  weight  of  meat  received  by  him.  Kings  Park 
State  Hospital  reported  that  their  records  of  distribution  from  October  i, 
191 1,  to  April  15,  1912,  showed  that  about  8  per  cent,  of  the  gross  weight  of 
beef  received  by  the  institution  was  delivered  by  the  butcher  to  the  kitchens 
in  the  form  of  bone-cuttings  and  fat.  The  total  unaccounted-for  shrinkage 
at  Kings  Park  was  less  than  1.5  per  cent. 

It  seems  clear  that  the  institutions  of  the  Department  of  Charities  under 
consideration  are  not  exercising  due  care,  either  in  their  system  of  handling 
meat,  or  in  their  methods  of  accounting  for  it. 

Food  Consumption 

It  was  impossible  to  examine  the  handling  of  food  in  the  Department  of 
Public  Charities  to  the  extent  that  it  was  examined  in  the  Department  of 
Bellevue,  owing  to  lack  of  time,  and  it  was  assumed  that,  if  the  per  capita 
amounts  of  food  used  in  the  Department  of  Charities  showed  a  marked 
variation  in  the  different  institutions,  the  detailed  method  of  inquiry  used 
in  Bellevue  could  be  subsequently  applied  by  the  Commissioner  of  Chari- 
ties to  the  hospitals  in  his  Department.  Accordingly,  the  only  examination 
made  in  the  Department  of  Charities  was  an  examination  of  the  total 
amounts  of  food  used  month  by  month  during  the  year  191 1  in  the  diiTerent 
institutions.  The  results  of  this  examination  are  set  forth  in  tables  on 
pages  616  to  626. 

By  referring  to  these  tables,  it  will  be  observed  that  there  is  a  marked 
difference  in  the  per  capita  consumption  of  the  same  articles  in  different  in- 
stitutions having  population  of  like  character.  For  instance,  of  flour  and 
wheat  products.  Kings  County  Hospital  used  175.78  pounds  per  capita 
per  year,  as  compared  with  290.95  in  City  Hospital.  Metropolitan  Hospital 
used  280.20  pounds  of  the  same  articles  of  food.  This  marked  difference 
in  the  amount  of  wheat  products  is  not  compensated  for  by  a  greater 


POOD   AND   FOOD    WASTE  597 

use  of  some  other  articles  having  similar  food  values.  Though  Kings 
County  Hospital  used  a  much  smaller  quantity  of  wheat  products  than 
City  or  Metropolitan  Hospital,  yet  its  consumption  of  beef  and  veal  was 
almost  proportionately  smaller,  having  been  174.40  pounds  per  capita  per 
year,  as  compared  with  190.65  pounds  in  City  Hospital,  and  191.25  pounds 
in  Metropolitan  Hospital.  Its  consumption  of  other  meats  was  in  about 
the  same  proportion  as  in  the  other  two  hospitals. 

The  total  amount  of  food  used  in  Kings  County  Hospital  was  1,376.47 
pounds  per  capita  per  year,  as  compared  with  1,649.39  in  City  Hospital, 
and  1,722.51  in  Metropolitan  Hospital.  A  portion  of  this  larger  per  capita 
consumption  in  Metropolitan  Hospital  may  be  legitimately  accounted  for 
by  the  necessity  of  using  eggs  and  milk  more  freely  as  a  diet  for  tubercu- 
lous patients.  Whereas,  Kings  County  Hospital  used  507  pounds  of  milk 
per  capita  per  year,  and  City  Hospital  588  pounds.  Metropolitan  Hospital 
used  741  pounds.  Likewise,  with  regard  to  eggs.  Kings  County  Hospital 
used  48  pounds  per  capita  per  year,  and  City  Hospital  54  pounds.  Metro- 
politan Hospital  used  86  pounds. 

A  still  more  marked  contrast  may  be  noticed  in  comparing  Cumberland 
Street  Hospital  with  the  two  hospitals  on  Blackwell's  Island.  Cumberland 
Street  Hospital  used  1,340.88  pounds  of  food  per  capita  per  year,  as 
compared  with  1,649.39  pounds  in  City  Hospital,  and  1,722.51  pounds  in 
Metropolitan  Hospital.  The  chief  items  of  food  of  which  there  was  less 
consumed  in  Cumberland  Street  Hospital  were  wheat  products,  beef  and 
veal,  eggs  and  milk.  It  is  also  interesting  to  observe  that  the  use  of  food 
per  capita  in  Coney  Island  Hospital  was  1,628.10  pounds  per  capita  per 
year,  as  contrasted  with  1,340.88  in  Cumberland  Street  Hospital.  The 
largest  use  of  food  was  noted  in  Bradford  Street  Hospital,  where  it 
amounted  to  2,042.36  pounds  per  capita  per  year.  The  excessive  amount 
can  be  partially  explained  by  the  fact  that  it  was  largely  served  to  officers 
and  employees,  there  being  an  average  of  about  one  patient  per  day.  This 
fact,  however,  is  hardly  sufficient  to  explain  the  issue  of  5.59  pounds  of 
food  per  capita  per  day,  which  includes  an  average  of  5  eggs  per  capita 
per  day.  The  consumption  of  cofifee  is  also  of  interest,  having  been  33 
pounds  per  capita  per  year,  as  contrasted  with  15  pounds  in  Coney  Island, 
and  II  pounds  in  Cumberland  Street,  Kings  County,  City,  and  Metro- 
politan Hospitals. 

The  amount  of  protein  in  the  food  supplied  makes  quite  as  interesting 
a  comparison.  In  Kings  County  Hospital  the  food  contained  108.79  grams 
of  protein  per  day,  as  compared  with  138.70  grams  per  day  in  City  Hospi- 
tal, and  143.74  grams  per  day  in  Metropolitan  Hospital.  On  the  other 
hand,  in  Cumberland  Street  Hospital  the  food  contained  but  100.61  grams 
per  day  per  capita,  while  in  Bradford  Street  it  contained  162.63  grams.  A 
like  difference  was  found  in  the  calories  in  the  food.  The  food  used  in 
Kings  County  Hospital  contained  3,021  calories  per  capita  per  day,  as  com- 
pared with  3,820  in  City  Hospital,  and  3,795  in  Metropolitan  Hospital.  In 
Coney  Island  Hospital  the  food  contained  about  the  same  number  of 
calories,  whereas  in  Bradford  Street  Hospital  it  contained  5,100  calories. 

Though  Kings  County  Hospital  seems  to  have  been  much  more  economi- 
cal than  the  hospitals  in  Manhattan  in  the  amount  of  food  used,  it 
was  not  more  economical  in  the  purchase  of  that  food.  The  average  cost 
per  pound  of  the  food  under  consideration  was  5.25  cents  in  Kings  County 
Hospital  as  compared  with  5  cents  per  pound  in  City  Hospital,  and  4.8  cents 
per  pound  in  Metropolitan  Hospital. 


598  HOSPITAL   COMMITTEE 

A  like  contrast  was  noted  between  the  amounts  of  food  used  in  the 
Homes  for  the  Aged  and  Infirm.  The  Brooklyn  Home  used  916.87  pounds 
of  food  per  capita  per  year,  as  contrasted  with  1,113.89  pounds  used  by  the 
Manhattan  Home.  In  other  words,  the  Manhattan  Home  used  over  21 
per  cent,  more  food  than  the  Brooklyn  Home.  This  is  not  only  true  as 
to  the  total  number  of  pounds  used,  but  also  true  as  to  the  protein  and 
calory  elements.  In  the  Brooklyn  Home  the  food  contained  85.79  grams 
of  protein  per  capita  per  day,  as  compared  with  104.96  grams  in  the  Man- 
hattan Home ;  and  in  the  former  the  food  contained  2,640  calories  per 
capita  per  day,  as  compared  with  3,301  in  the  Manhattan  Home.  Here, 
again,  although  there  was  a  marked  saving  in  the  Brooklyn  Home  in  the 
amount  of  food  used  as  compared  with  the  Manhattan  Home,  its  cost  per 
pound  was  greater;  viz.,  5  cents  per  pound  in  the  Brooklyn  Home,  as 
compared  with  4.5  cents  per  pound  in  the  Manhattan  Home.  The  record 
for  Farm  Colony  shows  that  both  the  amount  of  food  used  and  its  cost 
was  very  nearly  the  same  as  in  the  Manhattan  Home. 

A  detailed  examination  of  the  amount  of  beef  used  in  Metropolitan 
Hospital  and  City  Hospital  shows  that  the  issue  per  capita  was  somewhat 
heavier  in  the  6  warmer  months  of  the  year  than  in  the  6  colder  months. 
In  City  Hospital  the  average  daily  per  capita  issue  for  the  months  of 
January,  February,  and  March,  191 1,  was  .49  pound;  for  April,  May,  and 
June  the  same  amount ;  for  July,  August,  and  September  .48  pound ;  and 
for  October,  November,  and  December  .47  pound.  In  Metropolitan  Hos- 
pital the  average  daily  per  capita  consumption  for  January,  February, 
and  March,  191 1,  was  .53  pound;  for  April,  May,  and  June  .56  pound; 
for  July,  August,  and  September  .54  pound ;  and  for  October,  November, 
and  December  .50  pound.  It  is  remarkable  that  more  beef  was  supplied 
to  the  inmates  during  the  time  when  fresh  vegetables  were  abundant  than 
in  the  colder  winter  months,  when  vegetables  were  accessible  only  in  dried 
or  canned  form. 

It  is  interesting  to  compare  the  amount  of  food  used  by  the  hospitals  of 
the  Department  of  Charities  with  the  amount  used  by  the  New  York  State 
hospitals  for  the  insane.  The  average  per  capita  issue  of  food,  with  the 
exception  of  green  vegetables  and  cooking  accessories,  in  Binghamton, 
Rochester,  Kings  Park,  Middletown,  and  Utica  State  Hospitals  during  the 
year  ended  September  30,  1910,  was  1,236.57  pounds.  The  average  issue 
in  the  hospitals  in  the  Department  of  Public  Charities,  for  the  year  begin- 
ning January  i,  191 1,  was  1,605.66  pounds.  It  will  be  obser\'ed  that  the 
average  per  capita  issue  in  these  acute  and  semi-chronic  hospitals  was 
369.09  pounds  in  excess  of  that  used  in  the  insane  hospitals.  Inasmuch 
as  a  smaller  proportion  of  the  inmates  in  insane  hospitals  are  bed  patients 
than  in  acute  hospitals,  it  is  highly  probable  that  the  amount  of  nutriment 
required  by  the  patients  in  insane  hospitals  should  be  somewhat  greater 
than  for  patients  in  acute  and  semi-chronic  hospitals. 

This  difference  noted  in  the  per  capita  amounts  of  the  totals  of  food 
used  was  also  noted  in  connection  with  the  consumption  of  meat.  The 
five  State  hospitals  above  referred  to  supplied  their  patients,  on  an  average, 
204  pounds  of  meat  per  capita  per  year,  whereas  the  hospitals  in  the 
Department  of  Charities  supplied,  on  an  average,  266.86  pounds  per  capita 
per  year.  If  this  latter  amount  be  subdivided  according  to  the  hospitals 
in  Manhattan  and  The  Bronx,  and  those  in  Brooklyn,  the  average  amount 
used  in  the  Manhattan  and  Bronx  institutions  will  be  found  to  be  271.51, 
and  in  Brooklyn,  256.35  pounds  per  capita.     The  Manhattan  institutions 


FOOD   AND   FOOD    WASTE  599 

used  about  67  pounds  per  capita  more  than  did  the  State  institutions,  an 
excess  of  32  per  cent.  It  seems  improbable  that  the  patients  in  our  acute 
hospitals  should  require  more  of  this  heavy  diet  of  meat  than  is  required 
by  the  more  rugged  inmates  of  the  insane  hospitals. 

Though  the  amount  of  food  consumed  in  the  Children's  Hospitals  and 
Schools  on  Randall's  Island  was,  per  capita  per  year,  about  the  same  as  in 
Kings  County  Hospital,  namely,  1,315  pounds  in  the  schools,  as  compared 
with  1,376  pounds  in  Kings  County  Hospital,  nevertheless,  there  seems  not 
to  have  been  a  larger  proportion  of  milk  and  eggs  served  to  the  children 
than  was  used  in  Kings  County  Hospital.  In  the  Children's  Hospitals  522 
pounds  of  milk  per  capita  per  year  were  used,  as  compared  with  507.61 
pounds  in  Kings  County  Hospital.  The  Children's  Hospitals  used  but  25.26 
pounds  of  eggs  per  capita,  as  compared  with  48.63  pounds  used  by  Kings 
County  Hospital. 

In  considering  the  amount  of  food  necessary  for  use  in  the  hospitals  it  is 
interesting  to  note  the  fact  that  the  Municipal  Lodging  House  supplied  but 
1,066  pounds  of  food  per  capita  per  year,  as  contrasted  with  2,042  pounds 
used  by  Bradford  Street  Hospital;  1,628  by  Coney  Island  Hospital;  1,340 
by  Cumberland  Street  Hospital;  1,376  by  Kings  County  Hospital;  1,649  by 
City  Hospital;  and  1,722  by  Metropolitan  Hospital.  The  food  in  the 
Lodging  House  contained  but  93  grams  of  protein  per  capita  per  day,  as 
contrasted  with  an  average  of  131  grams  in  the  above  named  institutions. 
Some  inquiry  has  been  made  to  ascertain,  if  possible,  whether  the  amount 
of  food  furnished  in  the  Municipal  Lodging  House  seemed  to  be  sufficient. 
So  far  as  it  was  possible  to  learn  enough  food  is  furnished,  though  com- 
plaint is  made  as  to  the  manner  in  which  it  is  cooked  and  served. 

Food  Budget 

It  has  been  the  custom  of  the  Department  of  Public  Charities  in  esti- 
mating its  budget  for  food  to  take  the  total  amount  expended  for  food  for 
all  of  the  institutions  in  Manhattan,  Richmond,  and  The  Bronx,  and  sepa- 
rately the  institutions  in  Brooklyn,  and  to  add  thereto  a  percentage  for  an 
anticipated  increase  in  population.  No  effort  has  been  made  to  ascertain 
whether  or  not  the  money  expended  for  food  has  been  expended  for  the 
various  kinds  of  food  in  proper  proportion,  or  whether  or  not  certain  of 
the  institutions  were  using  more  of  certain  kinds  of  food  than  they  should, 
or  whether  or  not  there  had  been  waste  in  certain  institutions  that  should 
have  been  cut  down  by  allowing  a  less  amount  for  the  succeeding  year. 

Because  of  this  rather  unscientific  and  haphazard  method  of  determin- 
ing the  amount  of  money  needed  for  food  for  the  ensuing  year,  it  has  been 
deemed  advisable  to  submit,  for  consideration,  a  schedule  on  which  to  base 
an  estimate  of  the  amount  of  food  needed  in  the  hospitals,  and  also  in  the 
almshouses  of  the  Department.  A  suggested  schedule,  as  applied  to  the 
general  hospitals,  has  been  set  forth  in  table  form  on  page  608.  The  table 
provides  for  1,500  pounds  of  food  per  capita  per  year.  Kings  County  Hos- 
pital used  1,376  pounds  per  capita  during  the  year  191 1,  and  Cumber- 
land Street  Hospital  1,340  pounds,  whereas  Coney  Island  Hospital  used 
1,628  pounds;  City  Hospital  1,649  pounds;  and  Metropolitan  Hospital 
1,722  pounds.  Inasmuch  as  Kings  County  Hospital  apparently  served  its 
patients  and  employees  an  adequate  amount  of  food,  it  may  be  assumed 
that  City  Hospital  and  Coney  Island  Hospital  either  served  too  much  or 


6oo  HOSPITAL   COMMITTEE 

wasted  food.  According  to  the  table  Metropolitan  Hospital  would  be  al- 
lowed 845  pounds  of  food  additional  for  each  of  the  tuberculous  patients, 
which  would  make  an  average  of  1,900  pounds  per  capita  for  all  patients 
and  employees  in  the  institution. 

A  schedule  is  submitted  on  page  609  as  a  basis  for  estimating  the  num- 
ber of  pounds  of  the  various  kinds  of  food  needed  for  the  almshouses. 
This  table  provides  for  1,138  pounds  of  food  per  capita  per  year,  which  is 
a  larger  amount  than  was  used  during  191 1  by  either  of  the  City  Homes. 
The  Brooklyn  Home  used  but  917  pounds,  and  the  Manhattan  Home  but 
1,114  pounds  per  capita  per  year.  The  chief  items  of  increase  are  butter, 
mutton,  ham,  shoulder,  fresh  fish,  salt  fish,  canned  fruits,  and  vegetables. 
In  the  Brooklyn  Home  the  food  contained  but  85.79  grams  of  protein  per 
capita  per  day,  and  2,640  calories.  The  schedule  submitted  provides  for 
102.17  grams  of  protein  and  3,195  calories  per  capita  per  day.  This 
would  increase  the  food  elements  for  the  Brooklyn  Home,  and  give  about 
the  same  amount  supplied  in  the  Manhattan  Home ;  and  would  also  give 
a  more  acceptable  variety  of  food.  It  is  believed  that  the  proportions  and 
amounts  of  food  suggested  in  the  schedule  will  make  a  more  acceptable 
diet  for  the  inmates  and  provide  better  feeding. 

Department  of  Health 
Food  Consumption 

It  was  not  possible  to  make  a  detailed  examination  of  the  method  of 
handling  food  in  the  institutions  in  the  Department  of  Health  because 
of  lack  of  time.  The  books  of  the  institutions  in  that  Department  were 
examined  to  determine  the  total  amounts  of  the  different  kinds  of  food 
used  in  the  institutions  during  the  year  1912.  The  results  of  this  exami- 
nation will  be  found  in  tables  on  pages  627  to  630. 

Upon  examination  of  these  tables  it  will  be  observed  that  there  was 
considerable  difference  between  the  amounts  of  food  consumed  in  the 
different  hospitals  of  the  Department  dealing  with  approximately  the  same 
class  of  patients.  Willard  Parker  and  Kingston  Avenue  Hospitals  had,  in 
the  main,  the  same  class  of  patients.  Willard  Parker  Hospital  supplied 
1,655  pounds  of  food  per  capita  per  year,  as  compared  with  1,371  pounds 
in  Kingston  Avenue  Hospital.  The  amount  provided  in  Willard  Parker 
Hospital  contained  116  grams  of  protein  and  3,205  calories  per  capita  per 
day,  and  that  supplied  in  Kingston  Avenue  Hospital  contained  87  grams 
of  protein  and  2,578  calories  per  capita  per  day.  The  details  of  these 
quantities  are  of  special  interest.  Willard  Parker  Hospital  used  much 
more  meat  than  did  Kingston  Avenue  Hospital,  the  comparison  being  300 
pounds  per  capita  per  year  in  Willard  Parker  Hospital,  as  compared  with 
164  pounds  in  Kingston  Avenue  Hospital.  Willard  Parker  Hospital  also 
used  considerably  more  milk,  flour,  and  wheat  products.  On  the  other 
hand,  Kingston  Avenue  Hospital  used  35  pounds  of  eggs  per  capita  per 
year,  as  compared  with  22  pounds  in  Willard  Parker  Hospital.  Kingston 
Avenue  Hospital  used  50  pounds  of  sugar  per  capita  per  year,  as  com- 
pared with  41  pounds  in  Willard  Parker  Hospital. 

The  Sanatorium  at  Otisville,  which  is  devoted  exclusively  to  the  care  of 
tuberculous  patients,  used  more  food  per  capita  than  did  Riverside  Hospital, 
which,  though  caring  for  a  large  proportion  of  tuberculous  patients,  has  a 
certain  number  of  cases  of  mixed  contagion.  Otisville  Sanatorium  used 
2,447  pounds  of  food  per   capita  per  year,  as  compared  with  2,207  pounds 


FOOD   AND   FOOD    WASTE  6oi 

in  Riverside  Hospital.  The  chief  element  of  difference  between  Riverside 
Hospital  and  Otisville  Sanatorium  was  in  flour  and  wheat  products,  potatoes, 
canned  vegetables,  and  eggs.  Otisville  Sanatorium  used  considerably  less 
of  each  of  these  articles,  but  more  of  milk  and  meat,  than  Riverside 
Hospital. 

Both  of  these  institutions  used  a  much  larger  quantity  of  meat  than 
any  of  the  other  hospitals.  Otisville  Sanatorium  used  573  pounds  of  moat 
per  capita  per  year,  and  Riverside  Hospital  used  464  pounds.  This 
large  use  of  meat  prompted  an  inquiry  to  determine  what  proportion  of 
meat  other  tuberculosis  sanitaria  were  using.  The  number  of  pounds  of 
meat  per  capita  per  year  used  by  the  tuberculosis  hospitals  from  which 
reply  was  received  are  shown  below : 

Samuel  W.  Bowen  Memorial  Hospital,  Poughkeepsie,   N.  Y 227  Pounds 

Boston  Consumptives'  Hospital,  Mattapan,  Boston,  Mass 228       " 

New  York  State  Sanatorium  for  Incipient  Tuberculosis,  Raybrook,  N.  Y. . . .  296       " 

Metropolitan  Hospital,  New  York  City,  N.  Y 299       " 

Adirondack  Cottage,  Tmdeau,  N.  Y 410       " 

It  will  be  noticed  that  the  only  tuberculosis  hospital  using  an  amount  of 
meat  similar  to  that  used  in  most  of  the  municipal  hospitals  of  New  York 
City  was  the  sanatorium  at  Lake  Saranac  (Adirondack  Cottage),  formerly 
supervised  by  Dr.  E.  L.  Trudeau.  Under  date  of  August  5,  1913,  Dr.  Tru- 
deau,  in  a  letter  to  the  Director  of  this  investigation,  said : 

*  *  *  we  have  never  worked  out  the  per  capita  pounds  of  meat  con- 
sumed, *  *  *  We  make  no  special  effort  to  feed  patients  meat,  but  we  encour- 
age it  and  they  seem  to  crave  it,  and,  if  not  carried  too  far,  a  meat  diet  has  seemed 
to  me  a  favorable  factor  in  helping  to  arrest  the  disease.  As  I  said  before,  we  have 
made  no  special  effort  to  give  as  much  meat  as  possible,  nor  do  I  think  this  would 
be  advisable.  I  think  no  doubt  the  meat  portion  could  be  reduced  somewhat,  and 
flour  or  cereals  substituted  without  any  serious  risk. 

The  amount  of  meat  which  it  is  most  advisable  to  serve  to  tuberculous 
patients  seems  not  to  have  been  closely  determined.  Inasmuch,  however, 
as  the  sanatorium  at  Saranac  Lake  has  had  marked  experience  and  success 
in  the  treatment  of  incipient  tuberculosis,  its  method  of  treatment  and 
feeding  is  of  value  in  determining  the  amount  which  should  be  served  by 
our  municipal  institutions.  It  will  be  noticed  that  the  amounts  served  at 
Otisville  (573  pounds  per  capita  per  year)  and  Riverside  Hospital  (464 
pounds  per  capita  per  year)  are  considerably  in  excess  of  that  at  the  Saranac 
Lake  sanatorium ;  and,  moreover,  in  Riverside  Hospital  many  of  the  pa- 
tients are  not  tuberculous. 

It  is  suggested  that  the  schedule  for  estimating  the  amount  of  food 
needed  per  year  for  general  hospitals  could  be  applied  to  the  institutions 
at  Otisville  and  Riverside.  In  applying  it  to  these  institutions,  however, 
the  amount  of  food  required  for  the  employees  and  non-tuberculous  pa- 
jtients  would  be  figured  at  1,500  pounds  per  capita  per  year,  and  for  tuber- 
culous patients  the  amount  would  be  2,345  pounds  per  capita  per  year. 

General 

Institutions  have  given  too  little  attention  to  the  gross  amount  of  food 
necessary  to  furnish  an  ample  and  healthful  diet.  The  per  capita  yearly 
consumption,  as  found  by  your  Director,  in  the  State  institutions  caring 
for  a  like  class  of  patients  varied:  in  insane  hospitals,  from  1,089  to  1.481 
pounds;   in  soldiers'  homes,   from   1,232   to   1,723  pounds;   in   industrial 


6o2  HOSPITAL   COMMITTEE 

schools,  from  1,133  to  1,600  pounds;  in  reformatories,  from  948  to  1,209 
pounds;  and  in  prisons,  from  1,149  ^'^  i>740  pounds.  There  would  natur- 
ally be  a  variation  in  the  total  number  of  pounds  furnished  to  patients  or 
inmates  in  different  institutions,  according  to  the  proportion  of  different 
classes  of  food  used,  but  the  quantities  of  food  indicated  above  varied  in 
the  amount  of  protein  per  capita  per  day  from  89.64  to  122.43  grams,  and 
in  calories  from  2,962  to  4,157.  This  wide  variation  in  the  amounts  and 
varieties  of  food  provided  in  different  institutions  caring  for  the  same  class 
of  inmates  indicates  a  lack  of  adequate  consideration  on  the  part  of  the 
officers  in  control  of  the  important  problem  of  the  varieties  and  quantities 
of  food  necessary  for  satisfactory  feeding. 

The  municipal  institutions  in  New  York  City  apparently  have  given 
this  question  little  study,  inasmuch  as  the  total  quantities  and  the  propor- 
tions of  different  kinds  of  foods  varied  markedly  in  institutions  harboring 
the  same  class  of  patients  or  inmates.  It  has  been  determined,  with  a  rea- 
sonable degree  of  certitude,  that  active,  vigorous  males  performing  rea- 
sonably heavy  labor  throughout  the  day  do  not  require  more  than  120 
grams  of  protein  and  3,600  calories  per  capita  per  day.  Some  very  trust- 
worthy authorities  place  the  requirements  much  lower  than  this  amount. 
Patients  in  hospitals  and  inmates  in  almshouses  probably  require  consider- 
ably less  than  this  amount.  The  satisfactory  feeding  of  insane  patients, 
who  are  relatively  able-bodied,  on  100  grams  of  protein  and  3,000  calories 
per  capita  per  day  would  seem  to  indicate  that  general  hospitals,  with  a 
large  proportion  of  sick  patients,  and  almshouses,  whose  inmates  mostly 
are  infirm,  would  not  require  a  greater  amount  of  food  than  the  aver- 
age amount  used  in  insane  hospitals. 

As  previously  shown,  in  the  Department  of  Bellevue,  Gouverneur  Hos- 
pital provided  for  its  patients  and  employees  an  average  of  119.8  grams 
of  protein  and  2,959  calories  per  capita  per  day,  whereas  Harlem  Hospital 
provided  126.8  grams  of  protein  and  3,373  calories.  Bellevue  Hospital 
itself  provided  122.3  grams  of  protein  and  3,240  calories  per  capita  per  day. 
In  the  Department  of  Public  Charities,  Cumberland  Street  Hospital 
provided  100.6  grams  of  protein  and  3.038  calories  per  capita  per  day, 
whereas  City  Hospital  provided  138.7  grams  of  protein  and  3,820  calories, 
and  Metropolitan  Hospital  143.7  grams  of  protein  and  3,795  calories  per 
capita  per  day. 

In  the  Department  of  Health,  Kingston  Avenue  Hospital  provided 
87.26  grams  of  protein  and  2,578  calories  per  capita  per  day,  whereas  Wil- 
lard  Parker  Hospital  provided  116.48  grams  of  protein  and  3,205  calories. 
The  two  hospitals  caring  for  tuberculous  patients  provided  somewhat 
larger  amounts,  but  the  amounts  differed.  Riverside  Hospital  provided 
165.5  grams  of  protein  and  4,484  calories,  whereas  the  Sanatorium  at  Otis- 
vifle  provided  137.9  grams  of  protein  and  3,699  calories  per  capita  per 
day. 

These  iigures  show  marked  irregularity  in  the  amounts  of  food  served 
to  patients  of  like  character  in  the  same  department,  and  the  amounts  served 
to  patients  of  like  character  in  the  different  departments.  It  seems  highly 
desirable  that  a  recognized  standard  of  feeding  be  adopted,  taking  into 
consideration  the  different  classes  of  patients  to  be  fed.  It  is  the  opinion 
of  your  Director  that  for  patients  in  general  hospitals  the  proportions  need 
not  exceed  100  grams  of  protein  and  3,000  calories  per  capita  per  day;  for 
tuberculous  patients,  130  grams  of  protein  and  3,500  calories  per  capita 
per  day ;  for  inmates  of  alrnshouses,  90  grams  of  protein  and  2,800  calories 


FOOD  AND  FOOD   WASTE  603 

per  capita  per  day;  and  for  employees,  115  grams  of  protein  and  3,500 
calories  per  capita  per  day. 

Superintendents  of  hospitals,  or  heads  of  departments  operating  hos- 
pitals, have  been  somewhat  handicapped  in  their  endeavor  to  regulate  the 
kinds,  proportions,  and  total  amounts  of  food  furnished  to  the  patients 
and  employees.  This  has  been  due  in  a  measure  to  the  form  of  records 
used.  Practically  all  institutions  keep  their  accounts  of  food  purchased  and 
distributed  in  terms  of  dollars  and  cents,  and  when  periodical  reports  are 
made  to  the  head  of  the  hospital  or  department  a  summary  is  prepared 
in  like  terms.  It  is  very  difficult  for  the  officer  in  control  of  the  hospital 
or  department  to  quickly  determine  the  relative  amount  of  food  that  is 
being  used  when  such  food  is  reported  in  terms  of  money  only,  chiefly  be- 
cause the  market  prices  vary  from  time  to  time,  and  the  specifications  for 
food  may  be  different  in  different  periods.  In  order  to  get  an  accurate 
idea  of  what  has  actually  been  used  it  becomes  necessary  to  translate  the 
cost  figures  into  quantity  figures,  which  translation  is  very  seldom  made. 
A  superintendent  can  get  a  clear  idea  of  the  proportions  of  food  used  only 
when  such  proportions  are  stated  in  quantity  figures  rather  than  cost.  On 
an  average  a  given  number  of  patients  or  employees  will  consume  a  definite 
amount  of  food,  the  amount  for  the  patients  being  different  from  that  re- 
quired by  the  employees.  In  order  to  regulate  these  proportions  the  super- 
intendent should  have  before  him  monthly  a  statement  of  the  amounts  of 
different  kinds  of  food  that  have  been  served  during  the  previous  month, 
with  such  amounts  translated  into  terms  of  protein  and  calories.  He 
should  also  know  the  gross  amount  of  food  used  during  the  month,  and 
the  proportion  it  bears  to  the  estimated  amount  for  the  year.  With  such 
a  statement  in  hand  he  should  be  able  to  readily  determine  whether  or  not 
his  patients  are  being  served  an  adequate  amount  and  sufficient  variety  to 
constitute  a  satisfactory  diet.  He  will  also  know  whether  or  not  the  pro- 
portions of  food  being  used  exceed  the  proportions  allotted  by  the  budget 
for  the  year. 

For  the  purpose  of  placing  the  above-indicated  information  before  the 
superintendent  of  an  institution,  or  the  head  of  a  department  controlling 
an  institution,  it  is  suggested  that  a  form  similar  to  that  accompanying  this 
Report,  opposite  page  610,  be  adopted. 

Basic  Dietary  Tables  and  Waste  Accounting  System  in  Kings  Park  State 
Hospital 

In  the  fall  of  19 10  the  steward  of  Kings  Park  State  Hospital,  at  Kings 
Park,  Long  Island,  installed  a  system  of  separating  and  recording  waste 
from  the  dining  room  and  pantries,  and,  in  combination  with  this  system, 
devised  a  basic  dietary  table.  The  results  of  its  operation  for  nearly  three 
years  were  so  marked  that  it  seems  advisable  to  describe  it  in  some  detail, 
with  a  view  to  securing  its  adoption  in  our  municipal  hospitals. 

The  basic  dietary  table  is  designed  to  indicate  the  number  of  pounds 
to  be  issued  of  any  article  of  diet  for  a  given  number  of  patients  or  em- 
ployees. The  following  will  indicate  the  general  method  of  constructing 
this  table: 


604  HOSPITAL   COMMITTEE 

Number  of  Eaters.  150         160         170         ISO         190        200        210        220 

Ounces 

per        lbs.        lbs.         lbs.        lbs.        lbs.        lbs.        lbs.        lbs. 
Capita 

Roast  Beef 9  84  90  95}^     101         106}^     112         117^     123 

Potatoes  (peeled) .         8  75  80  85  90  95         100        105         110 

The  quantity  of  each  variety  of  food  has  been  estimated  for  a  certain 
number  and  increased  by  successive  additions  of  ten  "eaters."  When  the 
dining  room  census  exceeds  300  the  rate  of  increase  is  20  instead  of  10. 
Such  a  table  enables  the  steward  or  person  making  out  a  requisition  to  see 
at  once  the  number  of  pounds  that  should  be  entered  on  the  requisition  for 
the  number  of  patients  in  his  department.  It  requires  no  estimating  or  fig- 
uring. In  using  the  table  the  ratio  next  lower  or  higher  than  the  actual 
census  of  the  dining  room  is  used,  according  to  the  amount  of  waste  that 
has  been  reported  for  the  previous  issue  of  the  food  under  consideration. 
For  instance,  if  the  dining  room  census  showed  97,  and  potatoes  were  to 
be  issued,  and  according  to  the  waste  account  for  the  previous  issue  the 
waste  had  been  excessive,  the  next  requisition  would  be  based  upon  the 
amount  for  90  people.  Had  the  waste  been  below  normal  the  issue  would 
be  upon  the  basis  of  100  people.  Thus,  it  becomes  easy  to  increase  or  de- 
crease the  per  capita  amount  served  to  each  kitchen ;  such  increase  or  de- 
crease to  be  governed  by  the  amount  of  waste  previously  reported. 

The  waste  accounting  system  requires  the  person  in  charge  of  the  pan- 
try to  keep  together  all  food  returned  with  the  plates  as  one  class,  and  the 
food  not  served  on  the  plates  as  another  class ;  and  each  of  these  classes 
is  separated  into  food  articles,  so  that  the  steward  may  readily  know 
whether  or  not  any  particular  article  of  food  is  being  served  in  proper  pro- 
portions, or  is  acceptable  to  the  patients.  For  instance,  the  steward  of 
Kings  Park  State  Hospital  noticed  that  one  dining  room  was  returning 
much  more  bread  from  the  table  than  another,  each  of  which  dining  rooms 
was  receiving  the  same  per  capita  proportion  of  bread.  Upon  inquiry  it 
was  discovered  that  in  the  kitchen  serving  the  dining  room  which  had  re- 
turned the  larger  amount  of  bread  the  employees  had  cut  the  bread  several 
hours  previous  to  the  meal,  and  as  it  had  dried  off  on  the  surface  and  was 
not  palatable  a  smaller  proportion  of  it  was  eaten  than  in  the  dining  room 
where  it  was  freshly  cut.  This  was  detected  by  means  of  the  waste  ac- 
counting system,  and  probably  would  not  otherwise  have  been  discovered. 

During  the  6  months  from  July  i  to  December  31,  191 1,  AB  Kitchen 
returned  as  waste  food  from  the  plates  75,372  pounds,  and  CD  Kitchen 
returned  48,103  pounds.  During  the  same  period,  in  1912,  AB  Kitchen 
returned  59,839.  and  CD  Kitchen  32,634  pounds.  Thus,  in  these  two 
kitchens  alone  the  institution  apparently  saved  by  the  operation  of  the 
waste  system  during  a  period  of  6  months  about  31,002  pounds  of  usable 
food,  which  amount  was  probably  wasted  before  the  installation  of  the 
waste  accounting  system. 

No  difficulty  has  been  found  in  operating  the  system ;  it  does  not  inter- 
fere with  other  functions  of  the  kitchen,  pantry,  or  dining  room ;  it  gauges 
accurately  the  amount  of  food  needed  for  the  patients  and  the  kind  that 
they  will  readily  consume;  it  makes  all  the  employees  connected  with  the 
serving  of   food  much  more  careful,   inasmuch   as   it  is  possible   for  the 


FOOD   AND   FOOD    WASTE  605 

steward  at  all  times  to  ascertain  with  accuracy  exactly  what  is  occurring 
in  connection  with  the  handling  of  food. 

Because  of  the  success  of  the  system  as  operated  in  Kings  Park  State 
Hospital,  it  seems  advisable  to  suggest  that  a  similar  system  be  installed 
in  New  York  City  municipal  hospitals,  especially  in  connection  with  the 
dining  rooms  serving  employees,  in  which  dining  rooms  the  larger  propor- 
tion of  the  food  in  the  institutions  is  consumed.  It  probably  will  not  be 
feasible  to  adapt  the  system  to  the  feeding  of  patients  in  wards  without 
some  modification.  Though  the  system  is  not  so  readily  adaptable  to  ward 
service,  yet  the  amount  and  character  of  the  waste  coming  from  the 
wards  should  be  determined  as  a  gauge  to  the  service  needed  in  those 
wards. 

Suggestions  for  the  Reduction  of  Waste 

It  seems  advisable  for  municipal  hospitals  to  employ  such  help  as  may 
be  iiecessary  to  separate  and  weigh  the  waste  coming  from  the  dining 
rooms,  and  remaining  in  the  pantries.  To  insure  greater  accuracy  in  the 
issuing  of  food  to  the  dining  rooms  it  seems  advisable  to  provide  the 
kitchens  with  large,  graduated  dippers,  similar  to  the  one  shown  in  the 
illustration  on  the  opposite  page.  The  large  dipper  is  designed  to  be  used  in 
connection  with  soups,  stews,  tea,  coffee,  etc.,  and  will  hold  20  rations; 
5  rations  for  each  corrugation.  The  large  ladle  shown  has  a  capacity  of 
one  ration  of  any  of  the  varieties  of  food  served  in  the  large  dipper. 
The  small  dipper  is  designed  to  be  used  for  cereals,  and  the  small  ladle  has 
a  capacity  of  one  ration.  By  the  use  of  such  dippers  and  ladles  a  chef 
can  accurately  gauge  the  amount  of  each  article  of  food  sent  to  a  table 
or  dining  room,  and  if  the  one-ration  ladles  be  used  in  the  dining 
room,  the  amount  sent  from  a  kitchen  should  correspond  exactly  to  the 
services  from  these  ladles.  Where  new  steam  kettles  and  boilers  are  to 
be  installed  in  kitchens  it  is  advisable  to  have  them  graduated  similarly  to 
these  large  dippers,  so  that  the  chef  may  know  the  exact  number  of  ra- 
tions contained  in  each  kettle.  With  such  equipment  it  is  possible  to  accu- 
rately control  the  amount  of  food  prepared  and  served  to  a  dining  room, 
and  any  excess  waste,  as  observed  by  the  person  segregating  the  waste 
coming  from  the  dining  room,  can  be  regulated  in  future  service  by  these 
accurate  measures.  Such  dippers  and  ladles  are  in  daily  use  in  Kings 
Park  State  Hospital  and  have  proven  to  be  very  serviceable. 

As  a  suggested  basis  for  issuing  foods  in  our  mimicipal  hospitals  the 
table  on  page  606  is  offered.  This  table  indicates  the  ratio  of  each  kind 
of  food  per  person ;  and  the  total  amount  to  be  issued  to  a  dining  room, 
on  the  basis  of  the  number  served  in  the  dining  room.  The  table  as  pre- 
sented is  only  to  illustrate  the  method  of  constructing  a  table  for  the  use 
of  any  one  institution,  and  a  table  so  constructed  should  provide  for  the 
number  of  persons  in  each  dining  room  of  an  institution.  In  dining 
rooms  serving  less  than  300  the  table  may  be  constructed  upon  the  basis  of 
units  of  10;  for  instance,  the  amount  figured  for  60,  70,  80,  go,  100,  etc. 
For  dining  rooms  serving  more  than  300,  20  may  be  used  as  the  unit  of  in- 
crease, and  the  quantity  figured  to  be  served  to  300,  320,  340,  360,  etc.  The 
tables  should  be  placed  in  the  hands  of  the  dietitian,  the  storekeeper,  and 
the  chef. 

The  number  served  at  each  meal  in  each  dining  room  should  be  re- 
corded daily  and  sent  to  the  dietitian,  and  upon  this  count  the  requisitions 
for  the  second  day  following  should  be  based.  The  census  of  patients 
should  likewise  be  daily  sent  to  the  dietitian.     This  will  require  a  daily 


6o6 


HOSPITAL   COMMITTEE 


Basic  Dietary  Allowance  Table. 

This  Table  Shows  the  Basis  for  the  Requisitions  for  One  Meal  and  the  Quantities  are 
Expressed  in  Pounds,  Except  as  Otherwise  Indicated. 


Allowance  for  Employees 


Allowance  for  Patients 


Oz.  per      601  70  lOO      Oz.  per       200'  210  500 

Capita  Persons  Persons  Persons   Capita    Persons   Persons   Persona 


Roast  Beef 9 

Corned  Beef  Hash. .  4 

Fresh  Beef  Hash. . .  4 

Pot  Roast  (Beef) . .  9 

Salmon,  Canned ...  4 

Roast  Mutton 9 

Roast  Veal 9 

Hamburger  Steak. .  6 

Beef  Stew  Meat ...  6 
Mutton  Stew  Meat.      6 

Fresh  Fish 7 

Salt  Fish 6 

Oysters  or  Clams .  .  6  ea. 

Liver 6 

Cold  Meat 7 

Beefsteak 7 

Chops 8 

Ham 5 

Fresh  Pork 8 

Potatoes  (peeled) . .  8 

Tapioca Vs 

Sago *k 

Apples,  Evap IJi 

Peaches,  Evap 2 

Apricots,  Evap 2 

Gelatine i/s 

Macaroni 1)4. 

Beans IJ^ 

Cheese 1 J^ 

Green  Peas 1 

Split  Peas 1 

Eggs 1  or  2  ea 

Ham  with  Eggs 5 

Bacon 3 

Liver  with  Bacon. .  4 

Com  Meal '/lo 

Hominy '/lo 

RoUedOats "/s 

Wheatena */6 

Rice '/lo 

Wheat  Flakes Ve 

Canned  Vegetables,  .03168  g 

Crackers Vb 

Fresh  Vegetables ...  4 

Poultry 10 


33^ 

39 

56 

15 

171^ 

25 

3 

37J^ 

39}^ 

94 

15 

nV2 

25 

3 

371^ 

39}^ 

94 

331^ 

39 

56 

5 

63 

65}^ 

157}^ 

15 

17}^ 

25 

331^ 

39 

56 

3 

373^ 

39H 

94 

33H 

39 

66 

22M 

26 

37 

22  J^ 

26 

37 

3 

37^ 

39 

94 

22M 

26 

37 

3 

37^ 

39 

94 

26 

31 

44 

5 

63 

651^ 

1571^ 

22 1^ 

26 

37 

360 

420 

600 

6ea. 

1,200 

1,260 

3,000 

22  J^ 

26 

37 

26 

30^ 

44 

26 

30}^ 

44 

4 

50 

52H 

125 

30 

35 

50 

19 

22 

32 

5 

63 

65}4 

157H 

30 

35 

50 

4 

50 

52y2 

125 

30 

35 

50 

6 

63 

78 

188 

3 

3K 

5 

3 

3H 

5 

6J^ 

^V2 

11 

IM 

16 

16M 

39 

7^ 

8M 

121^ 

IVi 

19 

19M 

47 

^V2 

8M 

12  J^ 

IV2 

19 

19M 

47 

% 

y& 

IM 

4J^ 

5 

8 

1 

12J^ 

13 

31H 

53^ 

6^ 

9H 

IH 

19 

19M 

47 

5J^ 

6J^ 

9}i 

Wi 

19 

19M 

47 

Wi 

4M 

6 

'h 

7y2 

8 

19 

Wi 

4M 

6 

W2 

19 

19?^ 

47 

I 

1  ea. 

200 

210 

500 

18M 

22 

31 

11 

13 

19 

15 

nVi 

25 

3 

3 

4J^ 

V.0 

8H 

9 

22 

3 

3 

4J^ 

VlO 

m 

9 

22 

3 

3H 

5 

'h 

10 

WA 

25 

3 

3}^ 

5 

'U 

10 

wy2 

25 

3 

3 

m 

'h 

7y2 

8 

19 

3 

3H 

5 

Ve 

10 

lOH 

25 

jal.  2 

Wi 

3}^ 

.03168  gaJ 

I.  6K 

7 

17  f4 

3 

3J^ 

5 

*k 

10 

10^ 

25 

15 

17^ 

25 

4 

50 

52}^ 

125 

37J^ 

44 

62  J^ 

4 

50 

52J^ 

125 

'  This  table  should  be  expanded  in  ratios  of  10  allowances  to  provide  for  all  dining  rooms 
having  a  capacity  of  less  than  300.  For  dining  rooms  having  a  capacity  of  more  than  300 
the  ratio  of  20  should  be  used. 


FOOD   AND   FOOD    WASTE  607 

change  in  requisitions,  but  it  is  not  difficult  to  mal'ce  such  a  change,  owing 
to  the  fact  that  a  basic  dietary  table  will  indicate  at  a  glance  the  amount 
of  a  given  article  to  be  issued.  The  dietitian,  when  making  out  the  requisi- 
tion, should  stamp  upon  it  the  number  of  persons  to  be  served  by  such 
requisition.  The  storekeeper  and  chef,  having  in  hand  a  statement  of  the 
census,  will  be  enabled  to  check  any  mistake  made  by  the  dietitian.  The 
form  of  such  stamp  may  be  somewhat  as  follows: 


This  dietary  requisition  is  based  on  the  following  number  of  persons 

Patients  and  Employees 

Patients  only 

Employees  only 


The  census  on  which  such  requisitions  are  based  should  be  sent  daily  to 
the  chef,  and  posted  in  the  kitchen,  so  that  he  may  know  the  number  of 
persons  for  whom  he  is  to  prepare  and  issue  food. 

As  a  basis  for  estimating  for  budget  purposes  the  amount  of  food  re- 
quired for  a  hospital  for  a  year  the  schedule  on  page  608  is  submitted. 
This  schedule  has  been  devised  after  reviewing  the  amount  of  different 
classes  of  food  used  by  a  large  number  of  public  hospitals  and  institutions. 
It  is  believed  that  the  total  amount  of  food  provided  is  ample,  and  that  the 
proportions  of  the  various  kinds  of  food  are  such  as  to  secure  a  proper 
balance  of  food  qualities.  This  schedule  would  provide  123.53  grams  of 
protein  and  3,533  calories  per  day  for  each  of  the  general  patients,  which 
amount  is  ample.  It  will  be  noticed  that  for  tuberculous  patients  it  is 
suggested  that  an  additional  amount  of  144  pounds  of  beef,  veal,  and  mut- 
ton, 30  pounds  of  eggs,  and  671  pounds  of  milk  be  provided. 

This  table  provides  266  pounds  of  meat  per  capita  per  year  for  general 
hospitals,  which  is  somewhat  less  than  the  amount  now  served  in  Bellevue 
Hospital.  This  amount  of  meat  will  provide  8  ounces  per  capita  per  day 
for  patients,  and  16  ounces  for  employees.  The  amount  provided  for  pa- 
tients is  as  large  as  that  now  served  in  Bellevue  Hospital,  but  the  amount 
for  the  employees  is  somewhat  reduced.  To  show  how  this  amount  of 
meat  could  be  distributed  in  daily  rations  the  table  on  page  610  is  sug- 
gested. 

For  the  purpose  of  estimating  the  cost  of  the  1,500  pounds  of  food  indi- 
cated for  an  ensuing  year  it  is  suggested  that  a  study  be  made  as  to  the  feasi- 
bility of  choosing  certain  leading  articles,  such  as  flour,  potatoes,  beef,  mut- 
ton, butter,  sugar,  coffee,  eggs,  and  milk,  and  determining  their  market  value 
as  quoted  by  certain  recognized  trade  associations ;  the  estimate  of  the  total 
cost  of  food  to  be  varied  year  by  year,  according  to  the  variation  of  the  mar- 
ket prices  of  these  leading  articles.  The  price  of  each  article  would  have  to 
be  multiplied  by  the  proportionate  quantity  to  be  furnished,  as  indicated  by 
the  table,  and  the  total  increase  or  decrease  in  the  cost  of  the  varieties 
mentioned  be  then  considered  the  total  increase  or  decrease  of  the  aggre- 
gate amount  for  1,500  pounds  of  food.  In  other  words,  if  1,500  pounds  of 
food  during  the  year  ended  cost  $75.00,  and  of  that  amount  the  9  leading 
varieties  cost  $50.00,  and  by  comparison  of  current  market  rates  it  appears 


6o8  HOSPITAL   COMMITTEE 

that  these  leading  varieties  during  the  ensuing  year  will  probably  cost 
$55-00,  or  an  increase  of  $5.00  over  the  previous  year,  then  the  total  cost 
of  the  1,500  pounds  of  food  for  the  next  year  may  be  estimated  to  be 
$5.00  more  than  in  the  previous  year,  or  an  aggregate  of  $80.00.  This 
estimate  does  not  take  into  account  any  increases  or  decreases  in  tlie  prices 
of  the  other  varieties  of  food  included  in  the  table,  as  it  is  practically  im- 
possible to  determine  the  changes  in  the  prices  of  so  many  varieties,  and 
inasmuch  as  they  constitute  a  small  proportion  of  the  total  expenditure 
their  fluctuation  in  price  is  not  material. 

Suggested  Basis  for  Estimating  the  Number  of  Pounds  of  the  Different  Kinds 
OF  Food  to  be  Used  in  Municipal  Hospitals. 

The  following  list  of  foods  contains  all  varieties  except  fresh  fruits  and  fresh  vegetables, 
some  fancy  groceries,  and  cooking  accessories.  The  amounts  given  indicate  the  total  number  of 
pounds  per  capita  per  year.  To  determine  the  total  amount  of  food  required,  the  number  of 
pounds  per  capita  should  be  multiplied  by  the  average  census,  including  both  patients  and 
employees. 

Articles  Pounds 

Flour  and  Wheat  Products 290 

Corn  Meal  and  Hominy 10 

Oats,  Rolled  and  Meal 9 

Rice 7 

Beans  and  Peas  (Dried) 10 

Potatoes 225 

Butter 30 

Cheese 1.5 

Sugar 45 

Molasses  and  Syrup 2 

Beef  and  Veal 150  /'Add  144  lbs  \ 

Mutton 30  \     for  Tbc.»   / 

Pork 4 

Bacon 2 

Salt  Pork 0.5 

Ham  and  Shoulder 5 

Lard 2 

Fish,  Fresh 30 

Fish,  Salt 3 

Poultry 40 

Dried  Fruits 15 

Canned  Vegetables 15 

Canned   Fruits 10 

Coffee 11 

Tea 3 

Eggs 50  (Add  30  lbs  for  Tbc.') 

MQk 500  (Add  671  lbs.  for  The.') 

Total 1,500  = 

Note:  The  above  amount  of  food  would  produce  per  capita  per  day  123.53  grams  of 
protein  and  3,533  calories.  For  tuberculous  patients  181.20  grams  of  protein  and  4,600 
calories. 

'■  For  institutions  having  tuberculous  patients  only,  the  following  amounts  may  be  used : 

Patients    Employees 

Meat 410  lbs.       26G  lbs. 

Eggs SO     "  30     " 

Miik 1,171     "        430     " 

^Good  management  should  reduce  the  per  capita  consumption  of  food  below  1,500 
pounds  per  annum. 


FOOD   AND   FOOD    WASTE  609 

Suggested  Basis  for  Estimating  the  Number  of  Pounds  of  the  Different  Kinds 
OF  Food  to  be  Used  in  Almshouses. 

The  following  list  of  foods  contains  all  varieties  except  fresh  fruits  and  fresh  vegetables, 
some  fancy  groceries,  and  cooking  accessories.  The  amounts  given  indicate  the  total  number  of 
pounds  per  capita  per  year.  To  determine  the  total  amount  of  food  required,  the  number  of 
pounds  per  capita  should  be  multiplied  by  the  average  census,  including  both  inmates  and 
employees. 

Articles  Pounds 

Flour  and  Wheat  Products 340 

Com  Meal  and  Hominy 10 

Oats,  Rolled  and  Meal 9 

Rice 7 

Beans  and  Peas  (Dried) 8 

Potatoes 275 

Butter 20 

Cheese 0.5 

Sugar 45 

Molasses  and  Syrup 2 

Beef  and  Veal 130 

Mutton 50 

Pork 2 

Bacon 2 

Salt  Pork 0.5 

Ham  and  Shoulder 5 

Lard 2 

Fish,  Fresh 35 

Fish,  Salt 2 

Poultry 5 

Dried  Fruits 10 

Canned  Vegetables 2 

Canned  Fruits 2 

Coffee 10 

Tea 4 

Eggs 10 

Milk 150 

Total 1,138 

Note:  The  above  amount  of  food  would  produce  per  capita  per  day  102.17  grams  of 
protein  and  3,195  calories. 

Inasmuch  as  the  schedule  does  not  provide  for  fresh  fruits,  fresh  vege- 
tables, miscellaneous  foods,  and  cooking  accessories,  it  is  suggested  that 
$6.50  per  capita  per  year  be  added  to  cover  these  items,  which  is  about 
the  amount  expended  for  these  articles  by  Bellevue  Hospital. 

The  schedule  of  food  submitted  as  a  basis  for  estimating  the  total 
amount  of  food  needed  for  a  year  provides  266  pounds  of  meat  per  capita 
per  year  for  each  employee  and  patient.  If  the  census  of  Bellevue  Hos- 
pital were  2,256  this  ratio  would  provide  601,224  pounds.  The  table 
indicating  the  ratio  in  which  this  food  would  be  distributed  daily  shows  a 
distribution  of  but  551,803  pounds,  so  that  the  estimate  provides  for  49,421 
pounds  of  food  more  than  the  distribution  table  requires.  The  trimming 
waste  in  the  butcher  shop  would  not  exceed  i  per  cent. 


6io 


HOSPITAL   COMMITTEE 


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FOOD   AND   FOOD    WASTE 


6ii 


Amount  of  Protein  and  Number  of  Calories  in  Food  Products  as  Given  in  Bulletin 
No.  28  (Revised),  U.  S.  Department  of  Agriculture. 


Flour  and  Wheat  Products. 

Macaroni 

Com  Meal  and  Hominy .  .  . 

Oats,  RoUed  and  Meal 

Rice 

Beans  and  Peas 

Potatoes 

Butter  and  Butterine 

Cheese 

Sugar 

Syrup  and  Molasses 

Beef  and  Veal 

Mutton 

Pork 

Corned  Beef 

Bacon 

Salt  Pork 

Ham  and  Shoulder 

Lard 

Fresh  Fish 

Salt  Pish 

Poultry 

Dried  Fruits 

Canned  Vegetables 

Canned  Fruits 

Eggs 

Milk 


Per  Cent. 

Fuel  Value 

of 

per  Pound 

Protein 

Calories 

.104 

1,635 

.134 

1,665 

.092 

1,665 

.167 

1,850 

.08 

1,630 

.225 

1,605 

.018 

310 

.01 

3,605 

.259 

1,950 

.00 

1,860 

.024 

1,290 

.148 

1,040 

.13 

1.215 

.08 

2,215 

.143 

1,271 

.091 

2,795 

.074 

2,655 

.142 

1,675 

.00 

4,220 

.085 

205 

.139 

1,155 

.14 

800 

.028 

1,350 

.02 

300 

.005 

400 

.134 

720 

.033 

325 

Note:    A  pound  contains  453 . 6  grams. 


6l2 


HOSPITAL  COMMITTEE 


BELLEVUE  HOSPITAL. 
Food  Consumption,  Cost,  and  Value — Year  Ended  December  31, 
Average  Daily  Census,  Patients  and  Employees,  2,256. 


1912. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein      Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 143 .  62 

Com  Meal  and  Hominy 4 .  23 

Oats,  Rolled  and  Meal 4.86 

Rice 6.34 

Beans  and  Peas  (Dried) 5 .  23 

Potatoes 220.69 

Butter 29 .  73 

Cheese 1.38 

Sugar 42.77 

Molasses  and  Syrup 1 .  24 

Beef  and  Veal 159.26 

Mutton 82 .  53 

Pork 11.38 

Bacon 4.62 

Salt  Pork 1 .36 

Ham  and  Shoulder 12 .03 

Lard 3.00 

Fresh  Fish 27.21 

Salt  Fish 1 .36 

Poultry 42.07 

Dried  Fruits 13.35 

Canned  Vegetables 19 .87 

Canned  Fruits 13 .86 

Coffee 13.95 

Tea 2.77 

Eggs 75.31 

Milk 589.32 


$5.25 

14.94 

234,819 

.09 

.39 

7,043 

.15 

.81 

8,991 

.26 

.51 

10,334 

.25 

1.18 

8,394 

4.04 

3.97 

68,414 

9.34 

.30 

107,177 

.23 

.36 

2,691 

2.38 

.00 

79,552 

.09 

.03 

1,600 

15.79 

23.67 

165,630 

6.74 

10.73 

100,274 

1.45 

.91 

25,207 

.68 

.42 

12,913 

.12 

.10 

3,611 

1.56 

1.71 

20,150 

.32 

.00 

12,660 

1.84 

2.31 

5,578 

.15 

.19 

1,571 

6.45 

5.89 

33,656 

1.54 

.37 

18,022 

1.09 

.40 

5,961 

1.35 

.07 

5,544 

2.92 

.00 

000 

.40 

.00 

000 

11.95 

10.09 

64,223 

16.53 

19.45 

191,529 

Total 

1,533.34 

$92.96 

98.70 

1,185,544 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

4.19 

$.0606 

122.32 

3,240 

FOOD  AND   FOOD    WASTE 


613 


HARLEM  HOSPITAL. 

Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1912. 
Average  Daily  Census,  Patients  and  Employees,  j2p. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein     Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 135 .  35 

Com  Meal  and  Hominy 1 .  85 

Oats,  Rolled  and  Meal 3.39 

Rice 3.72 

Beans  and  Peas  (Dried) 3 .  04 

Potatoes 201 .50 

Butter 31.75 

Cheese .71 

Sugar 55 .  63 

Molasses  and  Syrup 1 .91 

Beef  and  Veal 185.53 

Mutton 62.62 

Pork 11.90 

Bacon 4.28 

Salt  Pork .31 

Ham  and  Shoulder 7.00 

Lard 4.84 

Fresh  Fish 16. 17 

"Salt  Fish .32 

Poultry 79.55 

Dried  Fruits 11 .05 

Canned  Vegetables 21 .  16 

Canned  Fruits 12.05 

Coffee 11.20 

Tea 2.86 

Eggs 51.00 

Milk 733.55 


S5.01 

14.08 

221,297 

.04 

.17 

3,080 

.10 

.57 

6,272 

.19 

.30 

6,064 

.16 

.68 

4,879 

3.71 

3.63 

62,465 

9.71 

.32 

114,459 

.14 

.18 

1,385 

3.08 

.00 

103,472 

.20 

.05 

2,464 

22.84 

27.46 

192,951 

6.26 

8.14 

76,083 

1.43 

.95 

26,359 

.54 

.39 

11,963 

.02 

.02 

823 

.99 

.99 

11,725 

.54 

.00 

20,425 

1.02 

1.37 

3,315 

.04 

.04 

370 

12.05 

11.14 

63,640 

1.30 

.31 

14,917 

1.20 

.42 

6,348 

1.16 

.06 

4,820 

2.33 

.00 

000 

.43 

.00 

000 

8.04 

6.83 

36,720 

20.66 

24.21 

238,404 

Total 

1,654.24 

S103.19 

102.31 

1,234,700 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

4.52 

$.0624 

126.80 

3,373 

6i4 


HOSPITAL   COMMITTEE 


GOUVERNEUR  HOSPITAL. 

Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1912. 

Average  Daily  Census,  Patients  and  Employees,  434. 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein     Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 125 .  4S 

Corn  Meal  and  Hominy 2 .  36 

Oats,  Rolled  and  Meal 3 .59 

Rice l.SS 

Beans  and  Peas  (Dried) 1 .  86 

Potatoes 174.90 

Butter 26.10 

Cheese .77 

Sugar 39 .  50 

Molasses  and  Syrup 1 .  14 

Beef  and  Veal 185.80 

Mutton 44.14 

Pork 4.83 

Bacon 2.48 

Salt  Pork .46 

Ham  and  Shoulder 15 .  67 

Lard .79 

Fresh  Fish 17.59 

Salt  Fish .25 

Poultry 47.57 

Dried  Fruits 8.03 

Canned  Vegetables 16.83 

Canned  Fruits 12.07 

Coffee 8.61 

Tea 2.42 

Eggs 89.11 

Milk 658.62 


S4.42 

13.05 

205,160 

.05 

.22 

3,929 

.11 

.60 

6,642 

.09 

.15 

3,064 

.08 

.42 

2,985 

3.30 

3.15 

54,219 

8.13 

.26 

94,091 

.18 

.20 

1,502 

2.24 

.00 

73,470 

.06 

.02 

1,471 

21.16 

27.50 

193,232 

4.79 

5.74 

53,630 

.60 

.39 

10,698 

.36 

.23 

6,932 

.04 

.03 

1,221 

2.16 

2.23 

26,247 

.09 

.00 

3,334 

1.15 

1.50 

3,606 

.03 

.03 

288 

7.24 

6.66 

38,056 

.94 

.22 

10,841 

.93 

.33 

5,049 

1.11 

.06 

4,828 

1.81 

.00 

000 

.40 

.00 

000 

14.10 

11.94 

64,160 

18.98 

21.73 

214,052 

Total 

1,492.85 

$94.55 

96.66 

1,082,707 

Consump- 
tion per 
Day 

Average 

Cost  per 

Pound 

Grams 
per 
Day 

Calories 
per 
Day 

4.08 

S.0633 

119.80 

2,959 

FOOD   AND   FOOD    WASTE 


615 


FORDHAM  HOSPITAL. 
Food  Consumption,  Cost,  and  Value — Year  Ended  December 
Average  Daily  Census,  Patients  and  Employees,  joy. 


!1,  1912. 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein      Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 137 .  07 

Corn  Meal  and  Hominy 6 .  74 

Oats,  Rolled  and  Meal 6.25 

Rice 4.41 

Beans  and  Peas  (Dried) 4.51 

Potatoes 168.60 

Butter 34 .  98 

Cheese 1 .21 

Sugar 51.82 

Molasses  and  Syrup 2.15 

Beef  and  Veal 165.51 

Mutton 84.24 

Pork 16.11 

Bacon 4 .  35 

Salt  Pork .29 

Ham  and  Shoulder 13 .  85 

Lard 2.23 

Fresh  Fish 23. 10 

Salt  Fish .51 

Poultry : 83 .44 

Dried  Fruits 19 .  96 

Canned  Vegetables 22.71 

Canned  Fruits 18.74 

CofEee 15.70 

Tea 4.47 

Eggs 55.98 

Milk 547.44 


14.64 

14.25 

224,109 

.14 

.62 

11,222 

.19 

1.04 

11,563 

.22 

.35 

7,188 

.23 

1.01 

7,239 

2.71 

3.03 

52,266 

10.88 

.35 

126,103 

.19 

.31 

2,360 

2.93 

.00 

96,385 

.20 

.05 

2,774 

17.60 

24.50 

172,130 

7.17 

10.95 

102,352 

1.93 

1.29 

35,684 

.64 

.40 

12,1.58 

.03 

.02 

770 

1.68 

1.97 

23,199 

.24 

.00 

9,411 

1.31 

1.96 

4,736 

.06 

.07 

589 

12.53 

11.68 

66,752 

2.37 

.56 

26,946 

1.26 

.45 

6,813 

1.72 

.09 

7,496 

3.29 

.00 

000 

.65 

.00 

000 

8.83 

7.50 

40,306 

15.35 

18.07 

177,918 

Total 

1,496.37 

S98.99 

100.52 

1,228,469 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

4.09 

$.0661 

124.58 

3,356 

6i6 


HOSPITAL   COMMITTEE 


METROPOLITAN  HOSPITAL. 
Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1911. 

Average  Daily  Census,  Patients  and  Employees,  z,2g^. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein      Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 280 .  20 

Com  Meal  and  Hominy 12 .  54 

Oats,  Rolled  and  Meal 7.42 

Rice 6.68 

Beans  and  Peas  (Dried) 10.28 

Potatoes 161.52 

Butter 27.68 

Cheese 1.26 

Sugar 43 .  54 

Molasses  and  Syrup 1 .  82 

Beef  and  Veal 191.25 

Mutton 29.22 

Pork 2.54 

Bacon 1.39 

Salt  Pork 2.55 

Ham  and  Shoulder 3 .  58 

Lard .88 

Fresh  Fish 28.01 

Salt  Fish 7.72 

Poultry 32.73 

Dried  Fruits 16.83 

Canned  Vegetables 6.22 

Canned  Fruits 5 .  18 

Coffee 11 .08 

Tea 3.76 

Eggs 86.26 

Milk 741.37 

Total 1,722.51 

Consump- 
tion per 
Day 

4.72 


S6.58 

29.14 

458,127 

.19 

1.15 

20,879 

.17 

1.24 

13,727 

.23 

.45 

9,258 

.44 

2.31 

16,499 

2.15 

2.91 

50,071 

7.24 

.28 

99,786 

.19 

.33 

2,457 

2.12 

.00 

80,984 

.08 

.04 

2,348 

16.65 

28.30 

198,900 

2.64 

3.80 

35,502 

.30 

.20 

5,626 

.22 

.13 

3,885 

.24 

.19 

6,770 

.49 

.51 

5,996 

.09 

.00 

3,714 

1.48 

2.38 

5,742 

.66 

1.07    • 

8,917 

4.99 

4.58 

26,184 

1.83 

.47 

22,720 

.30 

.12 

1,866 

.43 

.03 

2,072 

2.01 

.00 

000 

.46 

.00 

000 

12.82 

11.56 

62,107 

18.43 

24.47 

240,945 

S83.43         115.66  1,385,082 


Average        Grams        Calories 


Cost  per 
Pound 


per 
Day 


per 
Day 


$.0484  143.74  3,795 


FOOD   AND   FOOD    WASTE 


617 


CITY  HOSPITAL. 

Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1911. 

Average  Daily  Census,  Patients  and  Employees,  l,23S- 


Articles 


Pounds  of      Average        Protein     Fuel  Value 
Food  per       Cost  per       Pounds        Calories 
Capita  Capita      per  Capita  per  Capita 


Flour  and  Wheat  Products 290 .  95 

Com  Meal  and  Hominy 5 .  59 

Oats,  Rolled  and  Meal 9.05 

Rice 3.84 

Beans  and  Peas  (Dried) 12.21 

Potatoes 224.35 

Butter 32.81 

Cheese 1 .  56 

Sugar 46.84 

Molasses  and  Syrup 1 .  20 

Beef  and  Veal 190.65 

Mutton 44 .  83 

Pork 4.54 

Bacon 2.79 

Salt  Pork .08 

Ham  and  Shoulder 5.48 

Lard 1.12 

Fresh  Fish 31 .  13 

Salt  Fish 3.92 

Poultry 38.49 

Dried  Fruits 16.54 

Caimed  Vegetables 15.20 

Canned  Fruits 8.94 

Coffee 10.82 

Tea 3.64 

Eggs 53.97 

Milk 688.85 


$7.13 

30.26 

475,703 

.09 

.51 

9,307 

.21 

1.50 

16,742 

.16 

.31 

6,259 

.49 

2.75 

19,597 

2.97 

4.04 

69,548 

8.71 

.33 

118,280 

.23 

.40 

3,042 

2.27 

.00 

87,122 

.05 

.03 

1,548 

16.85 

28.22 

198,276 

4.20 

5.83 

54,468 

.55 

.36 

10,056 

.46 

.25 

7,798 

.01 

.01 

212 

.76 

.78 

9,179 

.12 

.00 

4,726 

1.89 

2.64 

6,381 

.33 

.54 

4,528 

6.30 

5.39 

30,792 

1.58 

.46 

22,329 

.71 

.30 

4,560 

.75 

.04 

3,576 

1.95 

.00 

000 

.50 

.00 

000 

8.07 

7.23 

38,858 

15.08 

19.43 

191,376 

Total 

1,649.39 

$82.42 

111.61 

1,394,263 

Consump- 
tion per 
Day 

Average 

Cost  per 

Pound 

Grams 
per 
Day 

Calories 
per 
Day 

4.52 

$.0499 

138.70 

3,820 

6i8 


HOSPITAL  COMMITTEE 


KINGS   COUNTY   HOSPITAL. 

Pood  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1911. 

Average  Daily  Census,  Patients  and  Employees,  l,i2y. 


Pounds  of      Average        Protein     Fuel  Value 
Food  per       Cost  per       Pounds        Calories 
Capita  Capita      per  Capita  per  Capita 


Flour  and  Wheat  Products 175 .  78 

Corn  Meal  and  Hominy 6 .  23 

Oats,  Rolled  and  Meal 5 .  19 

Rice 2.44 

Beans  and  Peas  (Dried) 3 .  35 

Potatoes 222.80 

Butter 32.16 

Cheese .65 

Sugar 43.25 

Molasses  and  Syrup .93 

Beef  and  Veal 174.40 

Mutton 43.27 

Pork 6.45 

Bacon 3.62 

Salt  Pork .40 

Ham  and  Shoulder 6 .39 

Lard .77 

Fresh  Fish 26.06 

Salt  Fish 6.03 

Poultry 16.20 

Dried  Fruits 9.87 

Canned  Vegetables 10.91 

Canned  Fruits 7.81 

Cofifee 11.66 

Tea 3.61 

Eggs 48.63 

Milk 507.61 


S4.33 

18.28 

287,400 

.10 

.57 

10,373 

.13 

.87 

9,601 

.10 

.20 

3,977 

.12 

.75 

5,377 

2.98 

4.01 

69,068 

8.48 

.32 

115,937 

.10 

.17 

1,267 

2.10 

.00 

80,445 

.03 

.02 

1,200 

16.48 

25.81 

181,376 

3.85 

5.62 

52,573 

.80 

.52 

14,287 

.57 

.33 

10,118 

.04 

.03 

1,062 

.87 

.91 

10,703 

.08 

.00 

3,249 

1.83 

2.21 

5,342 

.50 

.84 

6,964 

2.78 

2.27 

12,960 

1.00 

.28 

13,325 

.53 

.22 

3,273 

.68 

.04 

3,124 

2.01 

.00 

000 

.45 

.00 

000 

7.31 

6.52 

35,014 

14.10 

16.75 

164,973 

Total 

1,376.47 

S72.35 

87.54 

1,102,988 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

3.77 

$.0525 

108.79 

3,021.88 

FOOD   AND   FOOD    WASTE 


CUMBERLAND   STREET   HOSPITAL. 

Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  191L 

Average  Daily  Census,  Patients  and  Employees,  272. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein      Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 156 .  29 

Com  Meal  and  Hominy 4.41 

Oats,  Rolled  and  Meal 13.35 

Rice 3.31 

Beans  and  Peas  (Dried) 9 .  93 

Potatoes 236.95 

Butter 29.79 

Cheese 1 .  65 

Sugar 66.10 

Molasses  and  Syrup 2.15 

Beef  and  Veal 142 .  15 

Mutton 46.35 

Pork 6.05 

Bacon 3 .  36 

Salt  Pork 1.47 

Ham  and  Shoulder 5.54 

Lard 2.21 

Fresh  Fish 7.85 

Salt  Fish 13.43 

Poultry 17 .  72 

Dried  Fruits 18.02 

Canned  Vegetables 15 .87 

Canned  Fruits 11 .  66 

Coffee 11.24 

Tea 5.36 

Eggs 26.14 

Milk 482.53 


$3.65 

16.25 

255,534 

.07 

.41 

7,343 

.32 

2.23 

24,698 

.13 

.26 

5,395 

.39 

2.23 

15,938 

3.19 

4.26 

73,454 

7.82 

.30 

107,393 

.26 

.43 

3,217 

3.19 

.00 

122,946 

.08 

.52 

2,773 

13.13 

21.04 

147,836 

4.11 

6.02 

56,315 

.74 

.48 

13,400 

.53 

.31 

9,391 

.14 

.11 

3,902 

.76 

.79 

9,279 

.24 

.00 

9,326 

.40 

.67 

1,609 

1.13 

1.87 

15,512 

3.04 

2.48 

14,176 

1.82 

.50 

24,327 

.77 

.32 

4,761 

.99 

.06 

4,664 

1.93 

.00 

000 

.73 

.00 

000 

3.97 

3.50 

18,820 

13.04 

15.92 

156,822 

Total 

1,340.88 

S66.57 

80.96 

1,108,831 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

3.67 

S.0496 

100.61 

3,038 

620 


HOSPITAL   COMMITTEE 


CONEY   ISLAND   HOSPITAL. 

Food  Consumption,  Cost,  A^rD  Value — Year  Ended  December  31,  1911. 

Average  Daily  Census,  Patients  and  Employees,  150. 


Pounds  of      Average        Protein     Fuel  Value 
Food  per       Cost  per       Pounds        Calories 
Capita  Capita      per  Capita  per  Capita 


Flour  and  Wheat  Products 205.64 

Com  Meal  and  Hominy 5.17 

Oats,  RoUed  and  Meal 7.67 

Rice 4.00 

Beans  and  Peas  (Dried) 3.60 

Potatoes 293.60 

Butter 37.89 

Cheese 2.39 

Sugar 82.44 

Molasses  and  Syrup 2 .  53 

Beef  and  Veal 230.39 

Mutton 63 .59 

Pork 9.13 

Bacon 6 .  33 

Salt  Pork 2.00 

Ham  and  Shoulder 9.60 

Lard 3.96 

Fresh  Fish 29.73 

Salt  Fish 13.40 

Poultry 27.89 

Dried  Fruits 17. 16 

Canned  Vegetables 24.30 

Canned  Fruits 21.35 

Coffee 5.33 

Tea 5.77 

Eggs 3.09 

Milk 1.15 

Total 1,628 .  10 


S5.23 

21.39 

336,211 

.08 

.48 

8,608 

.18 

1.28 

14,190 

.16 

.32 

6,520 

.14 

.81 

5,778 

4.00 

528 

91,016 

10.05 

38 

136,593 

.38 

.62 

4,661 

4.00 

.00 

153,338 

.13 

.06 

3,264 

21.45 

34.10 

239,606 

5.70 

8.27 

77,262 

1.11 

.73 

20,223 

.84 

.49 

14,897 

.20 

.15 

5,310 

1.31 

1.36 

16,080 

.43 

.00 

16,711 

1.97 

2.53 

6,095 

1.06 

1.86 

15,477 

4.63 

3.90 

22,312 

1.74 

.48 

23,166 

1.11 

.49 

7,290 

1.90 

.11 

8,540 

2.62 

.00 

000 

.81 

.00 

000 

4.99 

4.43 

23,825 

12.33 

15.55 

153,124 

S88.55         105.07 


1,410,10 


Consump-      Average 

tion  per        Cost  per 

Day  Pound 


Grams 
per 
Day 


Calories 
per 
Day 


4.46 


S.0543  130.57  3,863 


FOOD  AND  FOOD   WASTE 


621 


BRADFORD  STREET  HOSPITAL. 

Food  Consumption,  Cost,  and  Value — ^Year  Ended  December  31,  1911. 

Average  Daily  Census,  Patients  and  Employees,  11. 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein     Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 279 .  91 

Com  Meal  and  Hominy 1.91 

Oats,  Rolled  and  Meal 4.08 

Rice 4.64 

Beans  and  Peas  (Dried) 4 .  46 

Potatoes 340.27 

Butter 70 .  00 

Cheese 1.82 

Sugar 84.84 

Molasses  and  Syrup 4 .  00 

Beef  and  Veal 166.36 

Mutton 89.73 

Pork 22.18 

Bacon 27.09 

Salt  Pork 2. 18 

Ham  and  Shoulder 33.36 

Lard 3.18 

Fresh  Fish 26.36 

Salt  Fish 6.82 

Poultry 73 .  63 

Dried  Fruits 9.64 

Canned  Vegetables 67.09 

Canned  Fruits 61 .09 

Coffee 33.63 

Tea 2.73 

Eggs 104.27 

Milk 527.09 


$7.25 

29.11 

457,652 

.03 

.18 

3,180 

.10 

.68 

7,548 

.18 

.37 

7,563 

.17 

1.00 

7,158 

4.64 

6.12 

105,483 

18.46 

.70 

252,350 

.28 

.47 

3,549 

4.18 

.00 

157,802 

.42 

.10 

5,160 

15.51 

24.62 

173,014 

8.30 

11.66 

109,021 

2.72 

1.77 

49,128 

4.26 

2.46 

75,716 

.20 

.16 

5,788 

4.57 

4.74 

55,878 

.33 

.00 

13,419 

2.37 

2.24 

5,403 

.44 

.95 

7,877 

13.14 

10.31 

58,904 

.84 

.27 

13,014 

3.10 

1.34 

20,127 

4.33 

.26 

20,436 

6.07 

.00 

000 

.47 

.00 

000 

15.70 

13.97 

75,074 

14.30 

17.39 

171,304 

Total 

2,042.36 

S132.36 

130.87 

1,861,548 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

5.59 

$.064 

162.63 

5,100 

622 


HOSPITAL  COMMITTEE 


NEW  YORK  CITY  HOME  FOR  THE  AGED  AND  INFIRM,  MANHATTAN. 
Food  Consumption,  Cost,  and  Value — ^Year  Ended  December  31,  1911. 

Average  Daily  Census,  Inmates  and  Employees,  3,017. 


Articles 


Pounds  of      Average        Protein     Fuel  Value 
Food  per       Cost  per       Pounds        Calories 
Capita  Capita      per  Capita  per  Capita 


Flour  and  Wheat  Products 348 .  78 

Com  Meal  and  Hominy 2 .  23 

Oats,  Rolled  and  Meal 6.47 

Rice 6.21 

Beans  and  Peas  (Dried) 8.39 

Potatoes 215.37 

Butter 15 .  49 

Cheese .38 

Sugar 59.94 

Molasses  and  Syrup 1 .  07 

Beef  and  Veal 126.79 

Mutton 75.51 

Pork 1.73 

Bacon 2.15 

Salt  Pork 12.00 

Ham  and  Shoulder .35 

Fresh  Fish 27.72 

Salt  Fish .15 

Poultry 7 .  64 

Dried  Fruits 17.30 

Canned  Vegetables .16 

Canned  Fruits .95 

Coffee 10.52 

Tea 4.08 

Eggs 11.97 

Milk 150.54 


18.09 

36.27 

570,255 

.03 

.21 

3,712 

.15 

1.08 

11,969 

.26 

.50 

10,122 

.33 

1.89 

13,465 

2.82 

3.88 

66,764 

4.15 

.15 

55,841 

.06 

.10 

741 

2.87 

.00 

111,488 

.27 

.03 

1,380 

9.96 

18.76 

131,862 

6.18 

9.81 

91,744 

.21 

.14 

3,831 

.36 

.20 

6,009 

1.18 

.89 

31,860 

.06 

.05 

586 

1.37 

2.36 

5,683 

.01 

.02 

173 

1.22 

1.07 

6,112 

1.65 

.48 

23,355 

.08 

.00 

48 

.08 

.00 

380 

1.88 

.00 

000 

.48 

.00 

000 

1.80 

1.60 

8,618 

4.56 

4.97 

48,925 

Total 

1,113.89 

S50.ll 

84.46 

1,204,923 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

3.05 

S.0449 

104.96 

3,301 

FOOD   AND   FOOD    WASTE 


623 


NEW  YORK  CITY  HOME  FOR  THE  AGED  AND  INFIRM,  BROOKLYN. 

Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1911. 

Average  Daily  Census,  Inmates  and  Employees,  1,653. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein     Fuel  Value 

Pounds        Calories 

per  Capita   per  Capita 


Flour  and  Wheat  Products 252.97 

Com  Meal  and  Hominy 10.49 

Oats,  RoUed  and  Meal 9.78 

Rice 5.66 

Beans  and  Peas  (Dried) 5.35 

Potatoes 197.89 

Butter 25.69 

Cheese .22 

Sugar 43.24 

Molasses  and  Syrup .17 

Beef  and  Veal 150.43 

Mutton 14.94 

Pork 1.30 

Bacon .59 

Salt  Pork 1 .33 

Ham  and  Shoulder .89 

Lard .06 

Fresh  Fish 33.50 

Salt  Fish 9.21 

Poultry 5.66 

Dried  Fruits 9.72 

Caimed  Vegetables 1 .99 

Canned  Fruits 1 .  92 

Coffee 16.93 

Tea 4.52 

Eggs 10.58 

Milk 101 .84 


S6.17 

26.31 

413,606 

.17 

.97 

17,466 

.25 

1.63 

18,093 

.23 

.45 

9,226 

.20 

1.20 

8,587 

2.62 

3.56 

61,346 

6.87 

.26 

92,612 

.     .04 

.06 

429 

2.11 

.00 

80,426 

.01 

.01 

219 

11.98 

22.26 

156,447 

1.32 

1.94 

18,152 

.24 

.10 

2,880 

.09 

.05 

1,649 

.14 

.10 

3,531 

.12 

.13 

1,490 

.01 

.00 

253 

1.65 

2.84 

6,867 

.76 

1.28 

10,638 

.83 

.79 

4,528 

.99 

.27 

13,122 

.09 

.04 

597 

.16 

.01 

768 

2.82 

.00 

000 

.53 

.00 

000 

1.60 

1.41 

7,618 

3.99 

3.36 

33,098 

Total 

916.87 

S45.99 

69.03 

963,648 

Consump- 
tion per 
Day 

Average 

Cost  per 

Pound 

Grams 
per 
Day 

Calories 
per 
Day 

2.51 

$.0501 

85.79 

2,640 

624 


HOSPITAL  COMMITTEE 


NEW  YORK  CITY  FARM  COLONY. 

Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1911. 

Average  Daily  Census,  Inmates  and  Employees,  766. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein      Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 343 .  57 

Com  Meal  and  Hominy 4 .  92 

Oats,  Rolled  and  Meal 10.65 

Rice 2.58 

Beans  and  Peas  (Dried) 13 .07 

Potatoes 154.63 

Butter 13 .60 

Cheese 3 .43 

Sugar 31 .  10 

Molasses  and  Syrup 1.51 

Beef  and  Veal 146.57 

Mutton 31 .26 

Pork 2.30 

Bacon 1 .72 

Salt  Pork 8.44 

Ham  and  Shoulder 1.81 

Lard .52 

Fresh  Fish 8 .25 

Salt  Fish 6.76 

Poultry 7.20 

Dried  Fruits 16.83 

Canned  Vegetables 5 .  69 

Canned  Fruits 3.76 

Coffee 11 .  27 

Tea 5.98 

Eggs 5.91 

MUk 201 .  15 

Total 1,044.48 


S8.46 

35.73 

561,736 

.08 

.45 

8,192 

.24 

1.78 

19,702 

.11 

.21 

4,205 

.54 

2.94 

20,977 

1.30 

2.78 

47,935 

4.11 

.14 

49,028 

.54 

.89 

6,689 

1.47 

.00 

57,846 

.45 

.04 

1,948 

12.79 

21.69 

152,432 

2. SI 

4.06 

37,980 

.32 

.18 

5,095 

.31 

.16 

4,807 

.94 

.62 

22,408 

.21 

.26 

3,031 

.06 

.00 

2,194 

.50 

.70 

1,691 

.57 

.94 

7,808 

1.34 

1.01 

5,760 

1.76 

.47 

22,720 

.30 

.11 

1,707 

.30 

.02 

1,504 

1.99 

.00 

000 

.77 

.00 

000 

1.07 

.79 

4,255 

6.48 

6.64 

65,374 

S49.S2 


82.61  1,117,024 


Consump- 
tion per 
Day 


Average 

Cost  per 

Pound 


Grams 
per 
Day 


Calories 
per 
Day 


2.86 


S.0476         102.66 


3,060 


FOOD  AND  FOOD   WASTE 


625 


NEW  YORK  CITY  CHILDREN'S  HOSPITALS  AND  SCHOOLS. 

Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1911. 

Average  Daily  Census,  Patients  and  Employees,  2,059. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein     Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 277 .  21 

Com  Meal  and  Hominy 5 .  14 

Oats,  RoUed  and  Meal 4.69 

Rice 5.89 

Beans  and  Peas  (Dried) 6 .  48 

Potatoes 187.78 

Butter 21.98 

Cheese .01 

Sugar 43.98 

Molasses  and  Syrup .21 

Beef  and  Veal 125.99 

Mutton 27.06 

Pork 3.02 

Bacon .90 

Salt  Pork 1.46 

Ham  and  Shoulder 2.83 

Lard .58 

Fresh  Fish 16.68 

Poultry 10.96 

Dried  Fruits 13.05 

Canned  Vegetables 2 .  73 

Canned  Fruits 1 .99 

Coffee 4.83 

Tea 2.04 

Eggs 25.26 

Milk 522.22 


$6.91 

28.83 

453,238 

.08 

.47 

8,558 

.11 

.78 

8,676 

.25 

.47 

9,600 

.25 

1.46 

10,400 

2.46 

3.38 

58,211 

5.82 

.22 

79,238 

.00 

.00 

20 

2.12 

.00 

81,820 

.00 

.01 

270 

10.75 

18.65 

131,030 

2.19 

.35 

32,877 

.37 

.24 

6,689 

.15 

.07 

2,515 

.15 

.11 

3,876 

.37 

.40 

4,740 

.06 

.00 

2,448 

.82 

1.42 

3,419 

1.78 

.15 

8,768 

1.21 

.36 

17,617 

.12 

.05 

819 

.16 

.01 

796 

.87 

.00 

000 

.28 

.00 

000 

3.78 

3.38 

18,187 

14.32 

17.23 

169,721 

Total 

1,314.97 

$55.38 

78.04 

1,113,533 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

3.60 

$.0421 

96.97 

3,051 

626 


HOSPITAL   COMMITTEE 


MUNICIPAL  LODGING  HOUSE. 

Food  Consumption,  Cost,  and  Value — ^Year  Ended  December  31,  1911. 

Average  Daily  Census,  Lodgers  and  Employees,  561. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein      Fuel  Value 

Pounds        Calories 

per  Capita   per  Capita 


Flour  and  Wheat  Products 286 .  74 

Com  Meal  and  Hominy 1 .25 

Oats,  RoUed  and  Meal 26.03 

Rice 1.87 

Beans  and  Peas  (Dried) 5.16 

Potatoes 142 .  37 

Butter 10.57 

Cheese .97 

Sugar 43.07 

Molasses  and  Syrup .20 

Beef  and  Veal 113.67 

Mutton 13.58 

Pork 1.89 

Bacon 2 .  28 

Salt  Pork 2.50 

Ham  and  Shoulder 3.35 

Lard 1.47 

Fresh  Fish 22. 19 

Salt  Fish .18 

Poultry 14.41 

Dried  Fruits 5.54 

Canned  Vegetables 3 .42 

Canned  Fruits 1 .32 

Coffee 23.84 

Tea .97 

Eggs 16.28 

Milk 321.57 


S6.62 

29.82 

468,819 

.02 

.11 

2,081 

.42 

4.34 

48,137 

.08 

.15 

3,048 

.50 

1.16 

8,282 

1.90 

2.56 

44,135 

2.67 

.11 

38,105 

.14 

.25 

1,892 

2.06 

.00 

80,110 

.01 

.00 

258 

10.71 

16.82 

118,217 

1.23 

1.76 

16,500 

.23 

.15 

4,186 

.39 

.21 

6,373 

.23 

.19 

6,638 

.46 

.48 

5,611 

.16 

.00 

6,203 

1.99 

1.89 

4,549 

.02 

.02 

208 

2.68 

2.02 

11,528 

.58 

.16 

7,479 

.15 

.07 

1,026 

.12 

.00 

528 

4.17 

.00 

000 

.12 

.00 

000 

2.46 

2.18 

11,722 

7.82 

10.61 

104,510 

Total 

1,066.68 

$47.94 

75.06 

1,000,145 

Consump- 
tion per 
Day 

Average 

Cost  per 

Pound 

Grams 
per 
Day 

Calories 
per 
Day 

2.92 

S.0449 

93.28 

2,740 

FOOD   AND   FOOD    WASTE 


627 


MUNICIPAL  TUBERCULOSIS  SANATORIUM,   OTISVILLE,   N.  Y. 

Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1912. 

Average  Daily  Census:  Patients,  487;  Employees,  35;  Total,  522. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein     Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 137 .  22 

Com  Meal  and  Hominy 10 .  44 

Oats,  Rolled  and  Meal 10.67 

Rice 4.90 

Beans  and  Peas  (Dried) 18 .  14 

Potatoes 222.45 

Butter 68.20 

Cheese 3 .50 

Sugar 72.62 

Molasses  and  Syrup 2 .  08 

Beef  and  Veal 277.84 

Mutton  and  Lamb 151 .  43 

Pork 14.12 

Bacon 9.95 

Salt  Pork 4.00 

Ham 27.56 

Lard 4.38 

Fresh  Fish 21 .79 

Salt  Fish 3.32 

Poultry 59 .  02 

Dried  Fruits 29.15 

Canned  Vegetables 16.53 

Canned  Fruits 18 .35 

Coffee 9.17 

Tea 3.41 

Eggs 63.03 

Milk 1,194.29 

Total 2,447.56 


$4.56 

14.07 

224,355 

.24 

1.06 

17,383 

.32 

1.78 

19,739 

.28 

.39 

7,987 

1.00 

4.08 

29,115 

6.34 

4.00 

68,960 

17.74 

.58 

209,811 

.53 

.10 

6,825 

4.09 

.00 

136,073 

.10 

.05 

2,683 

31.76 

41.12 

288,943 

16.99 

19.69 

183,987 

1.81 

1.13 

31,276 

1.65 

.91 

27,810 

.37 

.30 

10,620 

4.19 

3.91 

46,163 

.53 

.00 

18,484 

1.81 

1.85 

4,467 

.30 

.46 

3,835 

10.69 

8.26 

47,216 

3.33 

.82 

39,352 

.97 

.33 

4,959 

1.77 

.09 

7,340 

2.04 

.00 

.00 

.65 

.00 

.00 

10.18 

8.45 

45,381 

28.46 

39.41 

388,144 

$152.70        152.84 


Consump- 
tion per 
Day 


Average 
Cost  per 
Pound 


Grams 
per 
Day 


1,870,908 


Calories 
per 
Day 


6.67 


.06241 
.0767  2 


5,126 


'  Including  home  productions. 
'  Not  including  home  productions. 


628 


HOSPITAL   COMMITTEE 


KINGSTON   AVENUE   HOSPITAL. 
Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1912. 

Average  Daily  Census,  Patients  and  Employees,  408. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein      Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 110.75 

Com  Meal  and  Hominy .50 

Oats,  Rolled  and  Meal 13.98 

Rice 3.40 

Beans  and  Peas  (Dried) 5 .  29 

Potatoes 126.61 

Butter 25.60 

Cheese .45 

Sugar 50.20 

Molasses  and  Syrup .98 

Beef  and  Veal 56.28 

Mutton 39.75 

Pork 4.61 

Bacon 2.92 

Salt  Pork 1.01 

Ham  and  Shoulder 16.95 

Lard .81 

Fresh  Fish 16 .  19 

Salt  Fish 4.61 

Poultry 20.66 

Dried  Fruits 17.98 

Canned  Vegetables 26.37 

Canned  Fruits 15.30 

CofiEee 14.39 

Tea 2.46 

Eggs 34.96 

Milk •. . .  758.86 


S5.30 

11.52 

181,076 

.11 

.05 

832 

.43 

2.34 

25,863 

.18 

.27 

5,542 

.26 

1.19 

8,490 

2.45 

2.28 

39,249 

7.88 

.26 

92,288 

.07 

.12 

878 

2.90 

.00 

93,372 

.06 

.02 

1,264 

6.07 

8.33 

58,531 

4.56 

5.17 

48,296 

.57 

.37 

10,211 

.39 

.27 

8,161 

.12 

.07 

2,682 

2.22 

2.41 

28,391 

.09 

.00 

3,418 

1.56 

1.38 

3,319 

.39 

.64 

5,325 

3.64 

2.89 

16,528 

1.84 

.50 

24,273 

1.35 

.53 

7,911 

1.38 

.08 

6,120 

3.09 

.00 

000 

.46 

.00 

000 

5.54 

4.68 

25,171 

20.78 

25.04 

246,630 

Total 

1,371.87 

S73.69 

70.41 

943,821 

Consump- 
tion per 
Day 

Average 

Cost  per 

Pound 

Grams 
per 
Day 

Calories 
per 
Day 

3.75 

S.0537 

87.26 

2,578 

FOOD   AND   FOOD    WASTE 


629 


WILLARD   PARKER   HOSPITAL. 

Food  Consumption,  Cost,  and  Value — -Year  Ended  December  31,  1912. 

Average  Daily  Census,  Patients  and  Employees,  S49- 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein     Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 141 .  52 

Corn  Meal  and  Hominy 2 .  76 

Oats,  RoUed  and  Meal 9.42 

Rice 2.50 

Beans  and  Peas  (Dried) 3 .  52 

Potatoes 195.06 

Butter 31.54 

Cheese .26 

Sugar 41.40 

Molasses  and  Syrup .32 

Beef  and  Veal 147.15 

Mutton 70.07 

Pork 7.01 

Bacon 5.01 

Salt  Pork .75 

Ham  and  Shoulder 27.62 

Lard .50 

Fresh  Fish 19.88 

Salt  Fish 2.62 

Poultry 20.05 

Fruits,  dried 10.63 

Canned  Vegetables 19 .  50 

Canned  Fruits 8.79 

Co£Eee 10.54 

Tea 2.81 

Eggs 22.00 

Milk 852.42 


$5.05 

14.72 

231,385 

.05 

.25 

4,595 

.29 

1.57 

17,427 

.13 

.20 

4,075 

.16 

.79 

5,650 

3.72 

3.51 

60,469 

9.65 

.32 

113,702 

.04 

.07 

507 

2.38 

.00 

77,004 

.03 

.01 

413 

15.69 

21.78 

153,036 

7.92 

9.11 

85,135 

.87 

.56 

15,527 

.68 

.46 

14,003 

.09 

.06 

1,991 

3.73 

3.92 

46,254 

.05 

.00 

2,110 

1.83 

1.69 

4,075 

.24 

.36 

3,026 

3.53 

2.81 

16,040 

1.08 

.30 

14,351 

1.01 

.39 

5,850 

.84 

.04 

3,516 

2.28 

.00 

000 

.51 

.00 

000 

3.40 

2.95 

15,840 

22.66 

28.12 

277,037 

Total 

1,655.65 

$87.91 

93.99 

1,173,018 

Consump- 
tion per 
Day 

Average 
Cost  per 
Pound 

Grams 
per 
Day 

Calories 
per 
Day 

4.52 

$.0531 

116.48 

3,205 

630 


HOSPITAL   COMMITTEE 


RIVERSIDE   HOSPITAL. 
Food  Consumption,  Cost,  and  Value — Year  Ended  December  31,  1912. 

Average  Daily  Census,  Patients  and  Employees,  S48. 


Articles 


Pounds  of 

Food  per 

Capita 


Average 
Cost  per 
Capita 


Protein      Fuel  Value 

Pounds        Calories 

per  Capita  per  Capita 


Flour  and  Wheat  Products 162 .  74 

Com  Meal  and  Hominy 1.10 

Oats,  RoUed  and  Meal 11.02 

Rice 5.29 

Beans  and  Peas  (Dried) 8 .  07 

Potatoes 283.77 

Butter 37.57 

Cheese .75 

Sugar 72.77 

Molasses  and  Syrup .70 

Beef  and  Veal 227.96 

Mutton 80.43 

Pork 15.70 

Bacon 10.10 

Salt  Pork 5.00 

Ham  and  Shoulder 45 .  54 

Lard .01 

Fresh  Fish 21.45 

Salt  Fish 5.47 

Poultry 53 .  12 

Dried  Fruits 32.36 

Canned  Vegetables 38 .  78 

Canned  Fruits 10.56 

Cogee 17.29 

Tea 4.63 

Eggs 68.74 

Milk 986.57 

Total 2,207.49 


36.52 

16.92 

266,080 

.04 

.10 

1,832 

.34 

1.84 

20,387 

.28 

.42 

8,623 

.38 

1.82 

12,952 

5.47 

6.11 

87,969 

11.51 

.38 

135,440 

.11 

.19 

1,463 

4.20 

.00 

135,352 

.05 

.02 

903 

24.68 

33.74 

237,078 

9.36 

10.46 

97,722 

1.92 

1.26 

34,776 

1.42 

.92 

28,230 

.57 

.37 

13,275 

6.18 

6.47 

76,280 

.00 

.00 

42 

2.14 

1.82 

4,397 

.48 

.76 

6,318 

9.27 

7.44 

42,496 

3.41 

.91 

43,686 

1.89 

.78 

11,634 

.88 

.05 

4,224 

3.65 

.00 

000 

.85 

.00 

000 

10.45 

9.21 

49,493 

26.60 

32.56 

320,635 

$132.65    133.55 


Consump- 
tion per 
Day 


Average 

Cost  per 

Pound 

S.0601 


Grams 
per 
Day 


1,641,287 


Calories 
per 
Day 


2.  CHARACTER  AND  COSTS  OF  HOSPITAL  BUILDINGS 


FOREWORD 

It  is  desirable  to  know  whether  our  hospital  buildings  are  well  planned 
and  economically  built.  It  seemed  to  be  advisable  in  connection  with  the 
inquiry  carried  on  by  the  Committee  to  examine  such  elements  of  the  cost 
of  the  various  hospital  buildings  as  might  give  a  basis  of  comparison  in 
designing  buildings  yet  to  be  built. 

It  was  considered  best  to  make  the  examination  from  two  stand- 
points :  first,  to  ascertain  the  complete  cost  of  individual  buildings  and  to 
subdivide  these  costs  on  a  basis  of  bed  capacity;  and,  second,  to  have 
an  examination  made  of  the  buildings  by  a  thoroughly  competent  hospital 
architect  who  would  be  able  to  point  out  some  of  the  most  obvious  errors 
in  planning  and  construction.  The  examination  of  costs  was  made  by  Mr. 
John  P.  Fox,  of  New  York  City,  and  the  inspection  of  the  buildings  was 
made  by  Mr.  Edward  F.  Stevens,  architect,  of  Boston. 

It  is  not  assumed  that  the  criticisms  made  by  Mr.  Fox  and  Mr.  Stevens 
will  call  for  any  material  alterations  in  existing  buildings.  The  criticisms 
are  designed  primarily  to  show  wherein  errors  were  made  in  the  original 
planning  and  how  such  errors  may  be  avoided  in  future  buildings. 

The  buildings  have  been  grouped  in  classes ;  such  as  nurses'  homes, 
dormitories,  tuberculosis  pavilions,  and  ward  buildings;  and  the  buildings 
in  each  class  compared  with  an  arbitrary  standard.  In  each  case  the 
standard  was  based  on  a  building  of  fireproof  construction,  in  use,  or  in 
course  of  erection,  or  about  to  be  erected,  which  seemed  to  the  Committee 
to  be  most  suitably  and  economically  planned.  Each  standard  selected  has 
a  cost  price  of  30  cents  per  cubic  foot,  and  inasmuch  as  a  number  of 
hospital  buildings  of  the  Departments  of  Charities  and  Health  have  been 
constructed  for  this  amount  of  money  it  seemed  fair  to  adopt  30  cents  per 
cubic  foot  as  a  reasonable  standard  cost.  Good  hospital  buildings  are,  and 
should  be,  built  for  this  amount  of  money  at  the  present  time.  When  the 
bids  for  any  of  the  hospital  buildings  of  New  York  City  materially  exceed 
this  amount  per  cubic  foot  examination  should  be  made  to  ascertain  to 
what  the  excess  cost  is  due;  whether  faulty  planning,  expensive  material, 
or  insufficient  competition  in  bidding. 


633 


EXAMINATION  OF  BUILDINGS 

Boston,  Mass.,  October  8,  1913. 
Mr.  Henry  C.  Wright,  Director, 

Committee  on  Inquiry  into  Departments  of  Health,  Charities,  and 
Bellevue  and  AlHed  Hospitals  of  the  Board  of  Estimate  and  Appor- 
tionment. 

New  York  City. 
Sir:— 

Pursuant  to  your  request  that  I  investigate  the  newer  buildings  erected 
and  in  course  of  erection  for  the  Departments  of  Health,  Charities,  and 
Bellevue  and  Allied  Hospitals,  and  recommend  some  standard  of  work  and 
planning  which  would  be  helpful  in  passing  upon  the  plans  of  future 
hospital  buildings  of  the  City  of  New  York,  I  would  report: 

That  I  have  visited  many  of  the  new  and  a  few  of  the  older  buildings 
of  the  Departments ;  have  made  notes ;  studied  the  plans,  materials,  and 
expense  of  the  same;  have  compared  the  planning  with  the  best  planned 
hospitals  of  Europe  and  America;  and  have  endeavored  to  ascertain  the 
classification  of  patients  cared  for  in  the  Depai-tments.  From  my  own  ob- 
servation of  the  housing  of  the  sick  in  all  countries  I  would  offer : 

1st.  A  few  suggestions  of  standards  gathered  from  my  own  experience 
and  from  a  study  of  the  best  examples  throughout  the  world,  or  at  least 
of  what  would  appear  to  be  the  essentials  of  the  buildings  of  the  different 
groups. 

2nd.  An  opinion  of  where,  in  my  judgment,  existing  buildings  of  the 
above  Departments  could  be  made  more  efficient  and  where  in  future 
buildings  many  errors  which  have  crept  into  some  of  the  existing  structures 
may  be  avoided. 

Many  of  the  buildings  of  the  Departments  were  planned  before  the  real 
needs  of  a  hospital  were  known.  Some  were  planned  without  due  study, 
on  the  part  of  the  designer,  of  the  real  needs  of  the  buildings;  but  in  the 
later  buildings  the  improvement  is  very  marked,  both  in  planning  and 
detail. 

The  housing  of  the  great  multitudes  of  people  who  come  under  the  care 
of  the  Departments  of  Charities,  Health,  and  Bellevue  and  Allied  Hospitals 
is  a  study  that  in  itself  should  have  years  instead  of  days  in  which  to  make 
a  comprehensive  report. 

The  Site 

In  planning  any  institution  the  first  thing  to  be  considered  is  the  site. 
The  weather  conditions,  the  exposure,  the  environment,  all  have  to  do  with 
the  shape,  the  material  used,  and  the  nearness  to  other  buildings. 

As  a  rule,  it  might  be  safe  to  procure  enough  land  on  all  sides  of  the 
proposed  buildings  to  ensure  for  all  time  free  circulation  of  air  and  sun- 
shine. 

The  future  could  be  considered  in  placing  any  new  building  and,  so  far 

635 


636  HOSPITAL   COMMITTEE 

as  possible,  the  entire  group  should  be  blocked  out  and  the  grouping  made 
so  that  the  buildings  planned  for  a  certain  purpose  can  always  be  used  for 
that  purpose.  This  idea  is  being  carried  out  fully  by  the  Department 
of  Health,  I  understand,  in  its  new  hospital  at  Jamaica. 

The  best  location  for  the  central  plants,  such  as  kitchens,  laundries, 
and  heating  plants  should  be  determined  upon  :  for  the  kitchen,  one  suffi- 
ciently central  for  quick  delivery  of  food ;  for  the  laundry,  the  best  location 
of  service ;  for  the  heating  plant,  preferably  a  lower  grade  and  far  enough 
away  so  that  the  smoke  will  not  reach  the  patients'  buildings.  If  one 
group  of  buildings  is  near  another  it  is  always  economy  to  have  one 
central  heating  and  lighting  plant  and,  under  certain  conditions,  one  central 
laundry  and  baking  plant. 

If  a  sloping  site  is  considered  the  slope  should  not  be  toward  the  north, 
as  the  shadows  cast  by  the  buildings  would  be  longer,  and  consequently  the 
ground  colder  than  with  a  southerly  slope. 

At  Blackwell's  Island  I  found  five  institutions,  all  belonging  to  the  munici- 
pality of  New  York  City.  Each  institution  had  its  own  heating,  lighting, 
and  laundry  plants.  One  central  heating  and  lighting  plant  could  be 
maintained  at  vastly  less  expense.  A  central  laundn,'  where  all  the  clothes 
could  be  laundered  would  also  tend  to  lessen  the  running  expense. 

At  Kings  County  Hospital  and  Kingston  Avenue  Hospital,  both  owned 
by  the  City,  two  separate  heating  plants  exist  where  one  could  be  made 
to  do  the  work,  with  a  saving  of  labor  and  fuel. 

In  many  cases  I  found  electricity  being  purchased  from  public  service 
plants  when  the  steam  generated  for  laundry  and  heating  purposes  could 
have  been  passed  through  generating  engines  without  appreciable  loss. 

The  Ward  Unit 

Every  hospital  is  or  should  be  planned  for  one  purpose ;  and  that  is,  the 
best  care  of  the  patient.  Around  this  one  object  the  institution  should 
be  built.  That  this  requires  administrative  buildings,  homes  for  attendants, 
heating,  lighting,  washing,  and  food  supply  units,  is  only  that  the  patient 
may  have  the  best  care. 

The  ward  unit  should  be  planned  for  the  classification  of  the  disease 
which  is  to  be  treated.  The  conditions  which  govern  the  treatment  of  acute 
surgical  patients  are  different  from  those  governing  chronic  medical.  The 
ambulatorv  tuberculous  patient  needs  different  accommodations  from  the 
patient  suffering  from  the  same  disease  in  an  advanced  form ;  the  child 
from  the  adult ;  the  contagious  from  the  psychopathic. 

A  few  essentials  might  be  mentioned :  I  believe  that  whatever  the 
classification  of  the  patient,  the  ward  or  bed  of  the  patient  should  be  so 
placed  that  it  would  be  possible  to  have  sunshine  in  the  room  or  near  the 
bed  some  part  of  the  day ;  and  that  all  necessary  inside  doors,  and  all  doors 
or  windows  giving  access  to  porches,  should  be  designed  wide  enough  for 
the  patient  to  be  moved,  bed  and  all,  to  any  part  of  the  building,  porches, 
or  roof  without  discomfort  or  inconvenience. 

As  to  the  number  of  beds  to  be  placed  in  any  ward,  authorities  differ 
very  much.  The  best  German,  Dutch,  and  Danish  authorities  believe  that 
not  more  than  16  to  18  patients  should  be  in  one  room,  and  some  believe 
that  these  should  be  subdivided  with  screens  for  a  better  segregation. 

The  height  of  the  ceiling  may  depend  upon  the  classification  of  the 
patients,  but  any  height  above  12  feet  is  unnecessary  and  of  little  use  in  the 


CHARACTER  AND   COSTS   OF   BUILDINGS  637 

purification  of  the  air,  as  the  breathing  line  is  about  3  feet  from  the  floor. 
On  the  other  hand,  a  ward  of  more  than  10  beds  should  not  be  less  than 
10  or  II  feet  in  height.  Every  patient  should  have,  when  all  windows  and 
doors  are  closed,  at  least  1,000  cubic  feet  of  air,  or,  on  a  12-foot  basis,  83 
square  feet  of  floor  surface. 

There  should  always  be  a  quiet  room  with  i  or  2  beds  near  each  ward 
for  a  delirious  or  dying  patient. 

Roof  Ward 

Many  of  our  modern  hospitals  have,  for  economy's  sake, .  a  flat  roof. 
Some  of  the  hospitals  utilize  this  roof  to  a  certain  extent.  It  is  my  opinion 
that  every  ward  unit  should  have  its  roof  used  as  a  roof  ward,  not  merely 
a  flat  tiled  roof  where  a  patient  may  be  wheeled,  but  a  practical  roof  ward, 
partly  covered  for  protection  from  storms  and  intense  heat,  and  partly 
open  for  the  direct  rays  of  the  sun.  The  regular  ward  service  of  serving 
kitchen,  toilet  and  sink  rooms,  linen  and  supply  room,  should  also  be  pro- 
vided so  that  the  patient  may  spend  continuous  time  in  the  open. 

Serving  Kitchen 

Every  ward  unit  should  have  the  serving  kitchen  of  sufficient  size,  and 
so  placed  as  to  allow  of  quick  service  of  palatable  food.  There  should 
be  facilities  for  the  keeping  of  food,  warm  or  cold ;  for  cooking  small  diets ; 
for  laying  of  the  trays  for  the  patients ;  and  for  washing  the  ward  china. 
All  cases  for  china  and  supplies  should  be  free  from  the  walls,  as  should 
all  plumbing  fixtures. 

The  common  fault  of  most  serving  kitchens  is  to  make  them  too  small; 
and  the  arrangement  of  the  equipment  is  often  very  inconvenient.  Such 
rooms  should  be  carefully  planned  around  the  equipment,  instead  of  the 
equipment  having  to  be  adapted  to  the  room  after  the  building  has  been 
built;  and  the  equipment  most  used  should  be  located  so  as  to  be  most 
accessible,  with  things  adjacent  that  are  needed  together,  in  order  to  save 
time  and  confusion. 

Day  Room 

The  day,  or  convalescent,  room  is  considered  so  important  by  the 
German  Government  that  every  German  hospital  must,  by  law,  provide 
a  day  room  for  every  ward  unit.  This  day  room  is  about  10  per  cent,  of 
the  area  occupied  by  the  patients'  rooms,  or  about  g}/,  square  feet  to  each 
patient,  and  it  is  used  by  convalescents  for  dining  and  recreation. 

Sink  Room 

'  It  is  always  necessary  to  have  a  separate  room  for  the  emptying,  steriliz- 
ing, and  storage  of  bedpans  and  urinals,  and  similar  ward  service.  In  this 
room  the  soiled  clothes  container  may  be  placed,  unless  clothes  chutes  are 
used.  The  local  incinerator  is  sometimes  found  valuable  for  the  destroying 
of  ward  waste  and  may  be  placed  in  this  room.  Here  also  should  be 
placed  the  gas  stove  for  the  making  of  poultices,  the  ice  crusher  for  ice 
caps,  the  small  ice  storage  box,  the  blanket  warmer,  etc. 

Owing  to  the  constant  use  of  this  room,  as  well  as  the  serving  kitchen, 
the  walls  should  be  tiled  to  at  least  a  working  height. 


638  HOSPITAL   COMMITTEE 

Ward  Toilets 

The  simplest  form  of  plumbing  should  be  used  for  the  ward  toilets; 
water  closets  of  a  substantial  construction,  with  cut-away  "crescent"  seats, 
and  plumbing  pipes ,  as  little  exposed  as  possible.  The  wash  bowls  or 
trays  should  be  serviceable  and  solid ;  a  spray  supply  to  permit  washing 
under  running  water  is  considered  more  hygienic  than  the  old  style  of  bowl 
where  one  is  constantly  washing  in  soiled  water. 

The  subdividing  partitions  between  toilets  should  be  solid,  of  marble 
or  slate,  with  doors  having  springs  to  hold  them  open. 

Bathroom 

In  the  acute  cases  little  use  is  made  of  the  bathtub,  so  that  in  the 
general  surgical  or  medical  ward  unit  only  a  limited  number  will  be  needed. 
In  the  tubercular  ward  unit,  however,  ample  bathing  facilities  should  be 
provided,  both  for  tub  and  shower,  where  bathing  forms  a  part  of  the  treat- 
ment. In  any  case  where  the  patient  needs  assistance  in  being  bathed  the 
tub  should  be  elevated  from  the  floor.  In  the  children's  ward,  where  the 
bath  is  given  by  an  attendant,  the  high  shallow  slab  or  tub,  with  spray, 
should  be  used.  The  overflow  should  be  accessible,  and  all  pipes  so  planned 
that  they  can  be  cleaned  at  least  to  the  water  line  of  the  trap,  both  exterior 
and  interior. 

Linen  Room 

There  should  be  a  separate  storage  of  linen  for  each  ward  unit.  The 
linen  and  blankets  should  have  a  well  ventilated  room,  and  shelves  or  racks 
should  be  open  and  well  ventilated. 

Siu'geons'  Bowls 

There  should  be  a  sufficient  number  of  scrub-up  bowls  in  each  ward  unit, 
either  in  the  ward  or  corridors,  to  enable  the  visiting  surgeon  or  physician 
to  scrub  between  each  examination,  without  walking  too  great  a  distance. 

Division  of  Floor  Space 

From  a  careful  investigation  of  modem  ward  units  now  under  con- 
struction for  the  care  of  general  cases — of  from  18  to  24  beds  per  floor — it 
has  been  found  that  an  average  of  25  per  cent,  of  the  area  is  needed  for 
utilities,  staircases,  and  elevators,  and  25  per  cent,  for  corridors,  leaving 
50  per  cent,  for  patients.  Circumstances  will,  of  course,  change  these  pro- 
portions. In  wards  for  contagious  diseases  the  proportion  for  utilities 
would  be  greater,  while  for  incipient  tuberculosis  the  proportion  for  utilities 
would  be  less. 

Lighting 

The  lighting  of  the  ward  unit  by  day  or  night  is  important.  The  beds 
should  be  placed  so  as  to  shield  the  patients'  eyes,  and  the  night  light 
should  be  so  obscured  that  the  lighting  of  it  for  night  inspection  would 
not  necessarily  awaken  the  patients.  Direct  ceiling  lights  should  be 
avoided ;  reflected  lights  give  a  softer  and  more  agreeable  light.  A  wall 
outlet  at  each  bedside  provides  for  examination. 


CHARACTER  AND   COSTS   OF  BUILDINGS  639 

Portable  lights  have  disadvantages,  as  they  are  not  always  available 
when  wanted,  or  are  too  far  away.  The  best  arrangement  for  bedside 
lighting  has  been  found  to  be  a  portable  lamp,  which,  when  not  on  the 
table,  can  be  hung  up  on  the  wall  out  of  the  way. 

For  pleasant  lighting  of  wards  in  the  daytime  the  new  arrangement 
of  beds  found  in  the  Rigs  Hospital  at  Copenhagen  seems  to  give  good 
satisfaction.  In  this  plan  all  the  beds  are  parallel  to  the  outside  wall. 
None  of  the  patients  face  the  light,  the  windows  being  at  one  side;  while  the 
screens  between  the  groups  of  beds  tend  to  hide  other  windows. 

For  curtains  the  ordinary  roller  shade  is  not  nearly  so  satisfactory  as 
the  German  drapery  curtains.  The  latter  can  easily  be  removed  for  washing, 
and  can  be  made  to  overlap  at  the  center. 

Color  of  the  Ward  WaUs 

The  therapeutic  effect  of  color  is  very  marked  on  some  patients.  Soft, 
cheerful  colors  and  decorations  should  therefore  be  chosen,  and  in  the  chil- 
dren's wards  simple  and  amusing  pictures  could  be  used  with  great  success. 

Nurses'  Calls 

The  use  of  the  silent  electric  light  call  for  nurses  is  quite  as  effectual 
as  bells,  and  less  disturbing  to  the  patients.  A  similar  system  would  apply 
to  internes'  calls. 

Floors 

The  problem  of  the  best  material  for  floors  for  hospital  purposes  is  diffi- 
cult to  solve,  and  authorities  differ.  In  the  study  of  the  newer  European 
hospitals  one  finds  that  flint  tile  is  perhaps  used  more  than  any  other  floor 
material,  except  linoleum.  These  tiles  should  be  as  large  as  4  inches,  and 
either  square  or  hexagonal,   laid  with   a  coved  base. 

Terrazzo  forms  an  inexpensive  floor,  with  perhaps  as  good  results  as 
any  simple  material.  Two  colors  may  be  used,  one  for  the  base  and  one 
for  the  field,  with  the  dividing  line  made  by  a  line  of  single  tesser£e. 

Many  of  the  magnesite  floors  are  giving  good  results;  these  are  put 
down  in  a  plastic  form  and  in  varying  colors,  and  give  a  pleasing,  artistic 
efifect.  I  have  found,  however,  that  this  material  is  apt  to  disintegrate 
under  certain   conditions. 

A  wood  floor,  if  well  laid  and  kept  clean,  is  fairly  satisfactory;  but  its 
numerous  cracks  render  it  less  hygienic. 

Where  strictest  economy  must  be  practiced,  a  good  quality  of  cement 
is  recommended  as  having  served  its  purpose  well  in  many  an  institution. 

The  use  of  linoleum  is  growing  in  this  country,  and  it  seems  to  me 
that  when  properly  applied  on  a  smooth  surface  it  becomes  the  most  satis- 
factory floor  covering  for  the  wards,  private  rooms,  and  corridors.  If 
the  newer  colors  and  patterns  of  the  German  linoleum  are  used  the  eflFect 
is  very  pleasing. 

Perhaps  the  best  material  for  corridor  floors,  where  there  is  much 
traffic,  is  pressed  cork  tile,  this  being  even  more  resilient  than  linoleum  and 
better  for  heavy  wear. 

All  of  the  asphalt  materials  should  be  avoided,  except  for  special  condi- 
tions requiring  acid-proof  qualities  in  the  floor. 


640  HOSPITAL  COMMITTEE 

The  quarry  tiles  make  a  most  artistic  and  satisfactorily  wearing  floor 
for  the  service  portion  of  the  building  and  for  roof  wards  and  airing 
balconies. 


Examples  of,  and  Comments  on,  Ward  Units 

Riverside  Hospital 

The  new  pavilions  for  tuberculous  cases  appear  to  be  well  built  and 
very  economically  planned.  The  only  question  is  whether  too  much  economy 
has  not  been  practiced.  The  ceiling  heights  of  9  feet,  while  sufficient  when 
the  windows  are  all  open,  would  seem  too  low  when  the  windows  have  to 
be  closed  on  account  of  wind  or  storms.  The  bathing  facilities  for  patients 
consist  of  a  set  basin  for  every  5  patients  and  a  tub  or  shower  for  every 
10.     This  is  hardly  sufficient  for  the  best  practice. 

There  is  no  utility  room  provided  in  the  ward  unit,  a  practice  which 
appears  universal  in  the  Department  of  Health  and  seems  to  work  all 
right,  probably  owing  to  the  splendid  management  of  the  Superintendent. 

There  is  no  isolation  or  quiet  room  on  each  floor,  though  such  a  room 
may  not  be  needed  for  the  class  of  cases  to  be  treated. 

There  are  no  balconies  of  any  kind,  their  use  being  considered  unnec- 
essary because  of  the  large  size  of  the  windows.  While  the  casement 
windows  do  give  a  large  opening,  it  appears  questionable  whether  they  will 
prove  to  be  satisfactory,  especially  those  which  open  out  and  whose  fasten- 
ings do  not  appear  strong  enough  to  withstand  hard  wear  and  heavy 
winds.  Indeed,  one  window  on  one  of  the  new  buildings  was  found  to 
have  been  completely  blown  away. 

One  omission  in  the  buildings  which  it  is  proposed  to  remedy  is  that 
of  lockers  for  the  patients'  belongings,  which  now  have  to  be  kept  in  boxes 
at  the  heads  of  the  beds.  In  new  buildings  it  would  seem  advisable  to 
have  patients'  lockers  on  every  floor,  if  not  individual  dressing  rooms,  such 
as  are  found  in  the  plans  of  the  latest  tuberculosis  buildings  at  Otisville. 

The  lighting  provided  for  the  wards  is  too  glaring,  being  furnished  by 
large  frosted  ceiling  globes,  with  no  indirect  lights.  These  fixtures  were 
required,  I  am  told,  by  the  Department  of  Water  Supply,  Gas,  and  Elec- 
tricity. 


Kingston  Avenue  Hospital 

The  new  admitting  unit  is  well  planned,  providing  for  separate  service 
if  necessary  to  every  room  on  the  ground  floor.  This  is  developed  on  an 
improved  Pasteur  unit,  except  that  in  the  Pasteur  there  are  several  direct 
air  passages  across  the  building  between  the  utility  rooms  and  the  patients' 
cubicles. 

The  detail  of  interior  finish  is  unnecessarily  heavy,  and  expense  could 
have  been  avoided  by  the  use  of  plain  wood  sashes  and  doors  instead  of  all 
being  metal  covered.     The  steel  door  frames  are  good. 

As  the  building  is  not  finished  and  no  equipment  in  place  it  would  be 
hard  to  judge  of  the  efficiency  of  the  plan;  but  it  has  much  to  commend 
it  and  bids   fair  to  be  an  ideal  admitting  unit. 

The  measles  and  scarlet  fever  pavilions  were  examined,  but  require  no 
special  comment  as  they  seem  to  adequately  meet  the  needs. 


CHARACTER   AND   COSTS   OF  BUILDINGS  64I 

Willard  Parker  Hospital 

The  scarlet  fever  pavilion,  which  has  been  in  use  eight  years,  is  in 
splendid  condition,  except  the  solarium  on  the  roof,  which  has  leaked  badly, 
owing  to  poor  construction,  and  is  not  used.  The  building  was  an  expen- 
sive one,  which  can  be  accounted  for  by  such  things  as  an  elaborate 
ventilating  system,  a  considerable  height  of  floors ;  viz.,  14  feet  6  inches, 
and  the  extensive  use  of  tiling  for  all  the  floors. 

The  new  measles  pavilion,  practically  completed  but  not  equipped,  is 
excellently  planned,  and  worked  out  in  every  detail  with  proper  regard 
to  the  essentials  for  economical  administration  and  serving  the  patients, 
and  is  one  of  the  best  developed  plans  I  have  seen. 

In  the  admitting  department  of  the  first  floor  each  patient  is  put  into  a 
separate  or  private  room,  having  glazed  partitions  on  the  corridor  side 
to  facilitate  observation.  A  Dutch  door  opens  to  the  outer  airing  balcony. 
A  water  closet  and  a  bowl  are  provided  in  each  room. 

The  only  improvement  I  could  suggest  to  this  plan  would  be  to  have 
cut-olTs  between  the  patients'  rooms  and  the  utilities,  as  seen  in  the  Pasteur 
Hospital  in  Paris. 

In  the  upper  stories  the  wards  are  subdivided  with  glass  screens  for 
a  better  segregation  and  classification. 

Solaria  and  airing  balconies  are  provided  on  all  floors,  and  outdoor 
vented  clothes  chutes  are  provided. 

This  building  has  set  a  standard  as  to  what  an  isolation  hospital  for 
contagious  diseases  should  aim  for. 

Sea  View  Hospital 

There  are  certain  features  about  the  general  plan  of  Sea  View  Hospital 
which  are  good.  The  location  of  the  administration  building,  of  the  main 
kitchen,  storerooms,  and  dining  rooms,  is  central  and  convenient.  The 
position  of  the  power  house  on  the  west  side  of  the  buildings  is  not  the 
best  to  insure  freedom  from  smoke,  although  the  height  of  the  chimney 
may  prevent  any  trouble  arising  from  it. 

The  radiation  of  the  ward  buildings  from  a  semicircular  corridor  which 
surrounds  the  administrative  group  is  ingenious,  but  throws  all  ideas  about 
the  proper  orientation  of  hospital  buildings  to  the  winds,  literally;  for  the 
axes  of  the  buildings  lie  in  almost  every  direction  from  north  and  south 
to  east  and  west.  If  a  south  exposure  is  the  best  for  a  tuberculosis  ward, 
only  two  of  the  buildings  have  much  of  their  sides  towards  the  south. 
If  a  north  and  south  direction  is  the  best  for  the  axis  of  a  ward  building, 
as  believed  by  many  hospital  authorities,  then  only  two  buildings  conform 
to  this  plan.  The  "T"-shaped  arrangement  of  the  3  wards  on  each  floor 
still  further  complicates  the  way  the  beds  face. 

-  There  is  little  to  be  seen  in  the  plan  or  on  the  exterior  of  the  Hospital 
to  suggest  its  being  a  tuberculosis  institution.  The  large  dining  rooms  and 
the  broad  airing  balconies  on  each  side  of  each  floor  would  seem  to  indicate 
a  tuberculosis  hospital,  although  such  balconies  belong  to  general  hospitals 
as  well  as  to  those  devoted  to  the  treatment  of  tuberculosis. 

One  feature  of  the  arrangement  of  buildings  will  prove  expensive  in 
the  matter  of  operation,  and  that  is  the  number  of  elevators.  There  are  8 
elevators  in  the  ward  buildings,  each  requiring  an  operator.  If  each  opera- 
tor works  eight  hours,  then  24  operators  will  be  required.  With  a 
hospital  located  in  the  country,  with  unlimited  land  in  sight,  it  would  seem 


642  HOSPITAL   COMMITTEE 

as  though  the  ward  buildings  could  have  been  designed  either  low  enough 
to  avoid  elevators,  or  else  grouped  or  connected  so  as  to  reduce  the 
number  to  a  minimum. 

One  good  feature. of  the  ward  buildings  is  the  provision  of  small  wards; 
3  on  each  floor  of  all  but  two  buildings,  the  largest  wards  in  the  latest 
buildings  having  16  beds. 

There  is  nothing  about  the  administrative  end  of  the  ward  buildings 
to  suggest  provision  for  tuberculosis,  and  there  is  a  decided  lack  of  needed 
facilities.  The  bathing  facilities  are  insufficient  for  patients,  with  only  i 
bathtub  and  i  shower  on  each  floor,  for  from  25  to  29  patients,  and  these 
are  both  in  the  same  room,  with  no  privacy  whatever.  The  wash  basins  in 
some  of  the  buildings  are  shut  off  from  the  outside  light  by  a  high  parti- 
tion, which  is  not  satisfactory,  either  for  light  or  air. 

The  large  hydrotherapeutic  room  on  the  first  floor  of  the  ward  buildings 
could  not  be  considered  either  ideal  or  economical,  for  the  majority  of  the 
patients  for  this  treatment  should  be  under  the  direct  charge  of  a  physician 
who  would  prescribe  individual  treatment  for  individual  cases,  and  should, 
I  believe,  be  placed  in  a  central  bath  house  or  bath  department,  and  the 
more  simple  and  natural  bathing  facilities  provided  where  the  patients 
themselves  could  take  their  baths. 

It  is  my  opinion  that  lockers  should  be  provided  on  every  floor,  where 
each  patient  could  keep  his  own  personal  belongings  and  wraps.  These 
can  be  taken  care  of  to  some  extent  in  the  patients'  ward  bedside  tables, 
but  for  ambulatory  patients  these  lockers  should  be  provided. 

The  sink  rooms  are  very  complete,  indeed  too  complete.  There  is  cer- 
tainly an  excess  of  pressure  sterilizers,  as  3  are  provided  for  each  floor,  or 
nearly  100  for  the  group.  This  number  could  have  been  reduced  by  two- 
thirds. 

The  medicine  closets  appear  unnecessarily  elaborate  and  expensive,  with 
too  many  locks  and  keys.  Poisons  should  be  properly  protected,  but  a 
multiplicity  of  locks  seems  hardly  necessary  in  a  well  managed  hospital. 

The  ward  kitchens  appear  too  small  for  the  number  of  beds  on  a  floor. 
While  a  considerable  proportion  of  the  patients  are  expected  to  go  to  the 
main  dining  rooms  for  their  meals,  for  the  wards  where  this  will  not  occur 
it  would  have  seemed  wiser  to  provide  a  larger  and  more  convenient  space 
for  serving  meals  to  bed  patients. 

The  linen  closets,  which  should  be  of  the  simplest  construction,  are  lined 
and  even  ceiled  with  red  cedar,  with  close  shelving — an  unnecessary  expense 
for  an  institution  where  the  linen  and  blankets  are  being  changed  nearly 
every  day. 

The  plumbing  fixtures,  while  of  good  make,  were  not  designed  with 
reference  to  simple  care  and  cleanliness. 

The  floors,  which  appear  to  be  of  a  good  quality  of  wood,  should  be  of 
some  material  with  fewer  cracks,  as  linoleum,  terrazzo,  or  magnesite  com- 
position. 

A  curious  inconsistency  is  the  use  of  a  terrazzo  base  with  the  wooden 
floor.  Since  wood  was  used  for  the  floor,  it  might  just  as  well  have  been 
used  for  the  base;  for  it  could  have  had  the  same  cove  and  been  made 
flush  with  the  plaster  above. 

The  detail  of  the  finish  is  heavy,  which  might  have  been  almost  entirely 
eliminated  by  the  use  of  non-projecting  finish. 

The  balconies  are  convenient  to  all  3  wards  on  a  floor.  The  number  of 
doors  leading  directly  to  balconies  might  have  been  reduced  by  making 


CHARACTER   AND   COSTS   OF  BUILDINGS  643 

every  second  opening  a  window.  This,  too,  would  have  allowed  the 
placing  of  the  direct  radiators  under  the  windows  and  between  the  beds, 
instead  of  at  the  head,  as  at  present  arranged,  where  they  may  prove  to 
be  too  near  the  patients'  heads. 

The  radiators  should  have  been  of  a  type  more  easily  cleaned,  with  wider 
spaces  between  the  sections. 

While  the  environment  of  a  patient  has  its  effect  on  the  recovery  or 
depression  of  the  individual,  and  while  he  should  be  surrounded  as  far  as 
possible  with  beautiful  grounds,  cheerful  colors,  and  plenty  of  sunshine  and 
fresh  air,  it  would  not  seem  that  the  lavish  use  of  the  exterior  ceramic 
decorations  could  be  considered  as  having  any  therapeutic  effect  upon  the 
class  of  patients  that  will  occupy  the  building. 

The  surgical  building  was  unnecessarily  expensive  in  the  lavish  use  of 
wall  and  ceiling  tiles.  Some  of  the  details  are  good.  The  operating  depart- 
ment, too,  is  elaborate  to  a  fault.  The  absolute  separation  of  the  aseptic 
and  septic  rooms  is  uncalled  for.  That  is  to  say,  the  general  service  rooms 
might  well  be  the  same,  with  a  separate  operating  room  for  septic  cases. 
The  method  of  humidifying  the  air  and  other  complicated  details  might 
well  have  been  omitted. 

The  connecting  corridors  are  well  lighted,  but  unnecessarily  elaborate. 
The  expensive  method  of  opening  the  corridor  doors  might  be  criticised 
from  an  economical  standpoint,  both  as  to  construction  and  maintenance. 

The  kitchen,  service  building,  etc.,  will  be  mentioned  under  the  proper 
headings. 

City  Hospital 

As  there  are  no  recently  erected  ward  units  at  City  Hospital  there  are 
no  comments  to  be  made,  except  in  commendation  of  the  splendid  condition 
in  which  the  old  buildings,  after  half  a  century  of  use,  were  found.  The 
crowding  of  the  wards,  though  necessary,  is  of  course  to  be  deplored,  as 
many  of  the  patients  are  at  a  great  distance  from  the  outside  light  and  air. 

In  the  admitting  unit,  though  an  old  and  poorly  planned  building,  the 
patients  were  well  taken  care  of,  their  clothes  cleansed,  pressed,  and  hung 
up  as  carefully  as  in  a  Fifth  Avenue  clothing  store. 

The  kitchen,  laundry,  and  grounds  will  be  mentioned  under  their  re- 
spective headings. 

Metropolitan  Hospital 

The  only  new  ward  buildings  are  the  tuberculosis  pavilions.  The  best 
feature  of  these  are  the  wide  airing  balconies,  on  both  the  east  and  west 
sides  of  the  wards.  The  wards  were  originally  planned  for  14  beds,  7  on 
each  side,  with  doors  between  every  2  beds  to  give  access  to  the  balconies. 
In  the  new  wing  of  the  east  pavilion,  now  under  construction,  this  multiplic- 
ity of  doors  has  been  changed  to  the  arrangement  suggested  for  Sea  View, 
that  is,  with  alternating  doors  and  windows,  getting  the  radiators  further 
away  from  the  patients'  heads. 

In  the  existing  tuberculosis  pavilions,  where  many  of  the  patients  go 
outside  to  their  meals  in  a  common  dining  room,  no  advantage  was  taken 
of  this  fact  to  make  a  larger  use  of  the  administration  section.  In  the 
pavilion  under  construction  the  floors  have  been  carefully  planned  with 
proper  regard  for  the  patients  who  will  go  out  to  eat  and  those  who  will  be 


644  HOSPITAL   COMMITTEE 

fed  in  the  building.  As  a  result,  an  increase  of  14  per  cent,  in  the  number 
of  beds  has  been  possible. 

A  further  economy  has  been  effected  in  the  utility  rooms,  which  in  the 
older  building  had  considerable  unnecessary  plumbing. 

The  oldest  parts  Of  i\Ietropolitan  Hospital  are  in  a  remarkably  good  con- 
dition, testifying  to  the  able  administration  of  the  energetic  Superintendent. 
The  new  operating  rooms  in  the  old  rotunda  have  been  very  carefully 
thought  out,  and  are  very  complete  in  their  arrangements. 

In  planning  the  newer  buildings,  it  seems  a  mistake  to  have  kept  to  the 
style  and  material  of  the  older  buildings,  which  suggest  too  much  the  penal 
institutions  on  the  Island.  Of  all  buildings,  those  of  a  hospital  ought  to 
be  made  as  cheerful  as  possible;  and  while  a  uniformity  is  often  desirable 
in  architecture  in  constructing  new  buildings,  it  is  certainly  out  of  place 
when  it  tends  to  make  a  hospital  look  like  a  prison  or  workhouse.  There 
is  all  the  more  reason  to  change  the  type  of  building  on  Blackwell's  Island 
in  view  of  the  fact  that  the  stone  used  is  itself  of  a  dark  and  gloomy  color, 
and  also  because  there  is,  so  I  understand,  practically  only  one  quarry 
where  it  can  be  obtained,  which,  if  true,  would  tend  to  put  the  City  at  the 
mercy  of  the  owners  of  the  quarry. 

The  new  buildings  at  Kings  County  Hospital  set  an  excellent  standard  for 
a  cheerful  color  and  attractive  style  of  architecture.  In  view  of  the  greater 
prominence  of  the  buildings  on  Blackwell's  Island  it  would  seem  very  de- 
sirable to  begin  now  to  make  them  as  pleasing  as  those  of  Kings  County 
Hospital. 

The  grounds  on  the  Island  are  being  transformed  by  means  of  grading, 
grass  and  tree  planting,  and  cultivation  of  flowers. 

The  chapel  at  Metropolitan  Hospital  is  a  very  pleasing  contrast  to  the 
other  buildings  in  its  lighter  color  and  Gothic  style.  The  new  domestic 
building  as  planned  will  also  be  Gothic,  but  the  material  will  still  be  the 
dark  stone. 

Ejngs  County  Hospital 

The  older  buildings  of  this  Hospital  are  in  surprisingly  good  condition, 
considering  their  age,  and  constant  improvements  have  been  made. 

The  new  ward  building  has  some  of  the  best  ward  features  found.  The 
placing  of  one  wing  of  the  building  at  an  obtuse  angle  with  the  other  wing, 
for  the  evident  purpose  of  some  outside  architectural  effect,  is  hardly  to  be 
commended ;  but  the  putting  of  the  utilities  in  the  center  between  the  two 
ward  wings  is  a  good  feature,  conducive  to  economy.  Each  of  the  2  wards 
on  a  floor  has  its  own  patients'  toilet,  but  only  i  kitchen  and  i  utility  room 
are  required,  these  being  of  ample  size. 

The  main  wards  have  22  beds  each,  and  are  unnecessarily  wide  as  now 
used.  But  this  width  lends  itself  to  a  trial  of  the  Rigs  ward  idea.  By  put- 
ting in  low  screen  partitions,  set  out  from  the  walls  to  allow  passing  by, 
more  beds  can  be  introduced  than  now ;  the  patients  more  easily  segregated ; 
and  greater  comfort  afforded  them. 

The  new  ward  building  has  an  airing  balcony  at  only  one  end ;  but  also 
has  a  large  solarium  or  day  room  on  each  floor,  with  a  fire  tower  opening 
out  of  it.  There  are  2  small  quiet  rooms  on  each  floor,  for  3  patients  each, 
located  away  from  the  wards  and  all  possible  disturbances. 

The  details  of  the  building  are  better  than  usual,  though  some  things 
might  be  improved.    The  doors  have  a  heavy  wooden  trim,  which  is  un- 


CHARACTER   AND   COSTS   OF   BUILDINGS  645 

necessary,  but  they  are  properly  rounded  at  the  bottom,  and  the  curved  base 
of  the  walls  is  carried  around  the  door  frames. 

The  ward  and  hall  floors  are  of  a  magnesite  composition,  which  does 
not  make  a  good  appearance. 

The  walls  and  ceilings  are  finished  with  white  enamel  paint,  which 
looks  very  clean  but  is  really  too  bright,  and  will  be  more  or  less  uncom- 
fortable for  the  patients. 

The  wards  are  lighted  by  8  inverted  ceiling  lights,  another  example  of 
too  much  light  as  required  by  the  Department  of  Water  Supply,  Gas,  and 
Electricity. 

An  excellent  feature  of  the  administration  section  of  this  ward  unit  is 
a  basin  in  the  hall,  convenient  for  a  physician  or  nurse  to  wash  hands. 

The  new  children's  ward  building,  just  occupied,  shows  careful  plan- 
ning, with  proper  subdivisions  and  ample  outdoor  space  for  the  children. 
The  wards  are  sunny  and  each  one  opens  on  to  an  airing  balcony.  The 
roof  also  will  be  utilized,  having  a  playroom  as  well  as  the  open  space. 
The  wards  are  well  adapted  for  subdivision  by  screens,  so  as  to  permit 
more  beds  and  a  better  classification  of  patients.  In  the  case  of  children, 
the  screens  should  have  sections  of  glass,  to  allow  better  supervision.  The 
wards  are  equipped  with  basins,  facilitating  the  washing  of  hands  by 
physician  or  nurse.  The  toilet  rooms  have  slabs  for  the  washing  of  chil- 
dren. There  are  no  utility  rooms,  the  toilet  rooms  also  containing  the  slop 
sinks. 

The  wards,  and  corridors  also,  have  an  over-supply  of  electric  light, 
and  the  lights  are  so  arranged  that  they  must  all  be  turned  on  or  off  at  the 
same  time. 

The  least  satisfactory  feature  of  the  children's  building  is  the  condition 
of  some  of  the  floors,  most  of  which  are  of  linoleum,  laid  on  concrete.  The 
concrete  was  not  smoothed  off  enough  before  laying  the  linoleum  and  the 
latter,  as  a  result,  is  uneven  in  places. 


Bellevue  Hospital 

The  plans  of  Pavilions  A  and  B  of  the  new  buildings  are  in  many  ways 
extravagant,  both  as  to  floor  heights  and  disposition  of  the  general  utilities. 
It  is  my  opinion  that  the  comfort  of  the  patients  has  been  sacrificed  too 
much  to  architectural  lines,  although  the  architecture  of  the  buildings,  in 
spite  of  the  sacrifice,  is  somewhat  disappointing. 

These  pavilions  are  obviously  too  close  together,  especially  for  their 
height,  and  should  have  faced  the  south  instead  of  the  east,  which  would 
have  given  better  ventilation  and  more  hght.  The  arrangement  of  rooms 
leaves  much  to  be  desired.  The  toilet,  bath,  and  utility  rooms  are  prac- 
tically all  one,  which  certainly  should  not  be  the  case  with  such  large  wards. 
The  bathtub  is  in  line  with  the  door,  which  opens  on  an  inner  corridor, 
making  it  apparently  impossible  to  wheel  a  patient  into  the  room  on  a 
stretcher. 

There  is  no  separate  day  room  for  the  patients,  the  dining  table  for 
those  who  can  walk  to  their  meals  being  located  in  half  of  the  ward  kitchen. 
As  originally  planned  the  building  had  no  roof  wards  with  proper  utilities. 
The  wood  finish  of  the  wards  and  rooms  is  unnecessarily  heavy.  Steel  door 
frames  would  have  been  just  as  cheap  as  the  oak  ones,  and  the  projecting 
corners  and  angles  could  have  been  avoided.  One  elevator  is  certainly  in- 
sufficient for  a  building  with  nearly  400  beds. 


646  HOSPITAL   COMMITTEE 

One  of  the  most  questionable  features  of  the  wards  is  the  small  number 
of  windows.  Instead  of  having  a  window  on  each  side  of  every  bed,  as  is 
considered  the  best  practice,  there  is  only  i  window  to  every  2  beds,  and 
a  space  on  both  sides  of  the  wards  has  3  beds  against  a  blank  wall  with- 
out any  window.  The  restricted  size  of  the  court  makes  the  rooms  dark, 
especially  on  the  lower  floors,  while  the  loggia  adds  to  the  darkening,  and 
the  windows  do  not  go  up  to  the  ceiling  on  all  the  floors.  This  is  not  alto- 
gether surprising,  however,  because  one  floor  is  18  feet  6  inches  high  and 
another  15  feet  8  inches,  with  the  rest  15  feet,  all  much  higher  than 
necessary  for  hospital  floors,  the  air  space  above  12  feet  being  generally 
considered  of  no  value.  All  the  ceilings  at  Bellevue  are  over  12  feet  in 
height,  the  excess  ranging  from  about  lyi  feet  to  6^  feet. 

The  radiators  are  of  a  type  not  easily  cleaned,  and  the  openings  into  the 
ventilating  ducts  are  covered  with  gratings  instead  of  being  free  from  all 
obstructions  to  catch  dust. 

Pavilions  L  and  M,  now  under  construction,  show  marked  improve- 
ments over  A  and  B.  The  most  conspicuous  changes  are  those  evidently 
initiated  by  the  medical  expert  for  the  hospital.  Dr.  Goldwater.  It  is  un- 
fortunate that  it  was  considered  necessary  to  carry  out  the  architectural 
lines  of  the  first  buildings,  but  the  most  has  been  made  of  the  space.  The 
administration  rooms  have  been  greatly  improved.  Toilet,  utility,  and  bath- 
rooms have  been  separated  and  better  arranged.  A  day  room  has  been 
provided,  opening  out  of  the  ward  kitchen.  A  freight  elevator  has  been 
added.  Very  complete  roof  wards  have  been  provided,  with  kitchen,  toilet, 
and  dressing  rooms,  and  permanent  roofs  for  shelter.  Some  of  the  details 
might  have  been  improved,  but  probably  for  the  sake  of  uniformity  with 
the  first  buildings  no  changes  were  made.  The  same  heavy  wood  finish 
has  been  preserved,  and  a  cast  iron  rail  has  been  added  to  the  walls  to  pre- 
vent stretchers  from  injuring  the  plaster. 

The  floors,  which  are  of  wood  in  A  and  B,  are  being  laid  with  plastic 
linoleum,  a  magnesite  composition :  of  rather  uncertain  value  because 
magnesite  flooring  does  not  give  uniformly  good  results. 

The  plumbing  fixtures  appear  too  complicated  and  should  be  set  farther 
away  from  the  wall.  Each  ward  will  have  a  basin  near  the  farther  end, 
which  will  be  very  useful.  The  bathtub,  as  in  A  and  B,  is  in  the  way  of  the 
door  and  wheel  stretchers. 

The  heating  radiators  would  be  better  if  hung  from  the  walls.  The 
clothes  chute  is  very  large,  measuring  48  inches  by  39  inches  inside.  But  in 
spite  of  any  shortcomings  the  new  pavilions  are  a  great  improvement  over 
A  and  B. 

In  the  other  new  buildings  which  Dr.  Goldwater  has  planned  or  is  plan- 
ning for  Bellevue  he  has  made  the  most  of  a  restricted  situation,  and 
worked  out  most  interesting  plans,  so  that  the  institution  promises  to  be  a 
very  practical  one,  in  spite  of  the  early  mistakes  and  architectural  demands. 

Nurses'  Residence 

Perhaps  next  in  importance  to  the  care  of  the  patient  is  the  care  of  the 
nurse,  for  to  do  her  best  and  to  give  proper  care  and  comfort  to  the  un- 
fortunate sick  a  nurse  must  conserve  her  own  health  and  strength.  When 
"off  duty"  she  must  have  somewhere  to  go ;  out  of  the  environment  of  the 
sick  room;  out  of  the  sound  of  groaning  and  suffering  patients. 

I  believe  that  this  point  should  be  borne  in  mind  in  planning  a  home  for 


CHARACTER  AND   COSTS   OF  BUILDINGS  647 

nurses:  that  the  more  attractive  and  homelike  the  nurses'  building,  the 
more  alluring  the  position  seems  to  be  to  the  young  woman  who  is  taking 
up  nursing  for  her  life  work.  Consequently,  a  better  class  of  women  will 
be  attracted;  and,  the  better  the  nurse,  the  better  the  care  of  the  patient. 

As  her  work  when  on  duty  is  most  confining,  the  nurse,  whether  pupil 
or  graduate,  should  have  a  separate  room,  not  necessarily  large,  but  large 
enough  for  a  single  bed,  closet,  dresser,  and  study  desk.  This  can  be  ac- 
complished in  an  area  8  feet  8  inches  by  12  feet. 

There  should  be  ample  reception  rooms  for  the  receiving  of  friends, 
study  rooms  on  each  floor,  a  little  tea  kitchen  for  the  occasional  "spread," 
a  petty  laundry  for  the  nurses'  own  use,  and  ample  toilet  and  bathing  facili- 
ties on  every  floor.    There  should  be  both  shower  and  tub  baths. 

It  is  my  opinion  that  bowls  supplied  with  hot  and  cold  water  should  be 
placed  in  every  room,  as  this  will  economize  time  and  tend  to  greater  clean- 
liness. 

In  the  larger  homes  it  is  desirable  that  a  separate  kitchen  and  dining 
room  be  provided  in  the  building,  but  in  the  smaller  institutions  separate 
dining  rooms  adjoining  the  kitchen  building  tend  to  greater  economy. 

An  infirmary  for  sick  nurses  should  be  provided  in  every  large  home, 
with  hospital  provision  for  the  care  of  a  limited  number  of  nurses. 

Provision  should  be  made  for  the  nurse  to  sleep  out  of  doors,  either  on 
a  sleeping  porch  or  upon  a  balcony. 

The  nurses'  residences  at  nearly  all  hospitals  of  the  Departments  of 
Charities,  Health,  and  Bellevue  and  Allied  Hospitals  visited  have  been  given 
careful  and  thoughtful  consideration  for  the  comfort  of  the  nurses.  Some 
of  the  residences  are  still  planned  for  2  or  more  nurses  in  a  room,  but  all 
provide  comfortable  sitting  and  study  rooms  for  the  nurses. 

The  Nurses'  Home  at  Metropolitan  Hospital  is  well  arranged  and  sur- 
rounded by  a  beautiful  garden  on  the  water-front,  which  adds  to  its  at- 
tractiveness.    The  kitchen  and  dining  rooms  are  in  the  same  building. 

The  Home  at  Kings  County  Hospital,  with  its  rest  rooms,  its  study 
rooms,  and  sleeping  balconies,  its  gymnasium  and  roof  garden,  has  the 
charm  of  a  private  residence.  The  cost  of  this  modern  building  was  per- 
haps slightly  in  excess  of  some  of  the  other  homes,  but  I  believe  that  the 
attractions  of  the  Home  will  tend  to  keep  it  filled  with  desirable  nurses. 

The  Kitchen 

Next  in  importance  to  the  nursing  of  the  sick  is  the  feeding;  and  how 
to  serve  not  only  good  but  palatable  food  to  patients  scattered  over  an  area 
of  many  acres  is  one  of  the  problems  most  difficult  to  solve. 

In  many  of  the  great  hospitals  in  Europe,  where  institutions  occupy 
great  space  and  are  served  "over  ground" — that  is,  without  covered  corri- 
dors^ — the  food  is  taken  in  special  electric  trolley  cars,  as  in  the  case  of  the 
Steinhof  at  Vienna;  or  in  the  General  Hospital  at  Utrecht,  where  heated 
push  cars  running  on  tracks  are  provided;  or  in  the  great  Virchow  or  St. 
Georg,  where  food  is  carried  in  insulated  cars. 

The  kitchen  should  be  in  close  touch  with  the  storerooms  and  refriger- 
ating rooms,  and  at  the  same  time  should  be  centrally  located.  In  a  large 
institution  it  should  be  in  a  separate  building. 

Opinion  diflfers  greatly  as  to  where  the  kitchen  should  be,  whether  in  the 
upper  portion  of  the  domestic  building,  carrying  all  supplies  up  and  taking 
all  food  down :  or  on  the  ground  floor,  the  dining  rooms  above,  and  the 


648  HOSPITAL   COMMITTEE 

service  on  the  ground  floor  level.  There  is  much  to  be  said  in  favor  of 
either  way.  If  the  kitchen  is  up,  there  is  less  opportunity  on  the  part  of  the 
yard  man,  for  instance,  "dropping  in"  and  possibly  "sampling"  some  of 
the  good  things  and  taking  another  sample  for  his  friend.  This  would  not 
happen  were  the  kitchen  on  the  upper  floor.  If  there  is  an  overhead  con- 
nection to  one  of  the  upper  floors  of  the  ward  building,  one  moving  process 
is  eliminated  and  time  is  saved;  or  in  a  group  of  buildings  where  there 
are  first  story  or  basement  corridors,  as  in  the  Bispebjerg  Hospital  at 
Copenhagen,  I  consider  the  kitchen  on  the  ground  floor  level  conducive 
to   quicker  service. 

The  kitchen  should  be  well  ventilated.  For  this  the  top  story  would  be 
the  best  location. 

If  all  of  the  equipment  is  set  out  from  the  walls,  it  may  be  used  and 
cleaned  with  greater  facility. 

Gas  ranges,  where  gas  is  available,  are  generally  more  satisfactory  than 
coal,  as  there  is  no  dust  or  dirt  from  the  fire;  and,  with  the  modern  gas 
ranges,  there  is  greater  economy.  Gas  bakers  are  fast  taking  the  place  of 
the  brick  ovens,  occupying  one-tenth  the  space  and  having  greater  efficiency. 

Every  kitchen  should  have  its  diet  kitchen  in  close  contact,  where  the 
special  diets  are  prepared  and  where  much  of  the  training  of  the  nurses  is 
done. 

Steam  can  be  used  largely  in  cooking. 

With  the  great  improvements  in  electric  appliances,  much  of  the  cooking 
can  be  done  quickly,  and  also  economically,  where  the  current  is  generated 
on  the  premises. 

The  new  kitchen  of  City  Hospital  is  well  planned  and  is  on  the  third 
story,  with  direct  "bridge"  connection  to  the  ward  building.  This  facilitates 
quick  service. 

The  kitchen  at  Kings  County  Hospital,  built  on  the  same  general  plan, 
has  proven  very  efficient ;  but  the  glass  tile  walls  have  proven  too  fragile  for 
the  heavy  work  of  the  department. 

The  new  kitchen  of  Sea  View  Hospital,  built  on  the  first  floor,  with 
storerooms  below,  bids  fair  to  be  one  of  the  most  successful  in  the  City. 
The  ranges  are  located  in  the  center  and  steam  cookers  along  the  walls,  with 
bakery,  diet  kitchen,  and  scullery  in  close  proximity.  The  dining  rooms 
for  the  ambulatory  patients  are  arranged  at  either  side  of  the  main  kitchen, 
but  no  serving  rooms  are  provided,  the  plan  being  to  serve  directly  from 
the  ranges. 

The  food  for  the  wards  will  be  distributed  from  the  kitchen  by  a  unique 
system  of  distribution,  designed  by  the  architect  after  the  principle  of  the 
familiar  cash  carrier  system  in  stores.  The  food  will  be  taken  by  electric 
overhead  carriers  and  delivered  automatically  to  just  the  right  floor  in 
the  right  building.  One  cannot  help  feeling  that  a  good  deal  of  reliance  is 
being  placed  on  an  untried  system,  which  may  be  very  hard  to  operate  in 
case  of  a  breakdown,  as  it  is  difficult  of  access  in  the  tunnel. 

General  Stores 

There  must  be  some  general  storehouse  for  each  institution.  This  can 
be  planned  in  connection  with  one  of  the  domestic  buildings,  preferably  the 
kitchen.  The  general  stores  should  be  under  the  charge  of  a  competent 
steward,  who  would  receive  and  receipt  for  all  materials  received  at  the  in- 
stitution,  and  who  would  be  responsible   for  them.     If  the  pharmacy  is 


CHARACTER   AND   COSTS   OF  BUILDINGS  649 

located  in  another  portion  of  the  grounds,  the  druggist  should  receive  all 
articles  for  that  department.  But  great  care  should  be  taken  not  to  have 
too  many  exits  from  the  department  for  general  supplies,  and  there  should 
be  every  facility  for  receiving,  weighing,  and  storing  in  a  proper  way  all 
meats,  fruits,  and  vegetables  in  quantities. 

The  Laundry 

The  planning  of  the  laundry  should  be  considered  the  same  as  the  plan- 
ning of  a  factory,  to  economically  transform  the  crude  material  into  the 
finished  product.  From  the  time  the  soiled  clothes  enter  until  the  clean 
and  folded  goods  go  out  there  should  be  no  unnecessary  carting  backward 
and  forward;  but  the  machines  should  be  so  planned  and  arranged  that 
the  goods  will  go  steadily  forward  to  completion.  If  the  sorting  of  the 
soiled  clothes  is  done  into  boxes  on  trucks,  the  boxes  can  be  wheeled  at 
once  to  the  washers.  If  the  washers  are  large,  with  all  the  modern  im- 
provements, I  washer  properly  built  will  do  the  work  of  3  improperly 
constructed. 

If  the  extractors  are  grouped  together,  one  man  can  run  the  group,  and 
so  the  line  of  body  and  hand  ironers  should  be  in  line  with  the  dry  room 
and  conveyers.  The  mangle  and  hand  ironers  should  be  near  the  linen 
room. 

Light  and  air  are  essentials  and  the  linen  or  stock  room  should  be  well 
ventilated,  with  shelves  of  slate,  to  allow  a  free  circulation  of  air. 

It  is  economy  to  have  the  stock  linen  room  and  the  washed  linen  store- 
room in  one,  so  that  the  requisitions  can  be  quickly  filled  without  replenish- 
ing the  stock  from  the  general  storeroom.  Here  all  of  the  linen  should  be 
mended  and  other  sewing  done. 

Should  the  location  demand  a  multi-storied  building,  the  laundry  or 
washing  work  should  be  started  at  the  top  and  finished  ironing  done  below. 
An  elevator  will  take  the  material  up  and  its  own  weight  will  bring  it  down. 

The  laundries  of  the  Department  of  Health  at  Riverside  Hospital  and 
Kingston  Avenue  Hospital  seemed  especially  well  arranged  and  handled. 
At  both  places  the  clothing  is  all  brought  into  a  receiving  room,  cut  off 
from  the  rest  of  the  laundry  by  a  sealed  steel  partition,  into  which  are  built 
sterilizing  washers.  The  dirty  clothes  are  put  into  these  washers,  and  are 
removed  on  the  inner  side  only  when  thoroughly  washed  and  sterilized. 
The  newer  laundry  at  Kingston  Avenue  Hospital  has  an  excellent  linen 
room,  and  efficient  methods  of  keeping  track  of  the  laundry  and  supplies. 

The  new  laundry  at  City  Hospital  was  not  in  operation,  so  that  little 
can  be  told  about  it.  Gas  instead  of  electric  irons  were  in  use  in  all  these 
laundries,  in  deference  to  the  unfortunate  requirements  of  the  Department 
of  Water  Supply,  Gas,  and  Electricity. 

The  new  laundry  at  Sea  View  Hospital  contains  elaborate  sterilizers, 
although  the  Department  of  Health  seems  not  to  need  them  for  a  like  class 
of  patients. 

Staff  Residence  and  Help's  Quarters 

In  every  great  hospital  unit  it  is  essential  to  have  proper  quarters  for 
the  staff,  and  for  the  male  and  female  employees,  as  well  as  for  the  nurses. 

The  medical  students  who  are  giving  their  time  for  years  and  attending 
the  sick  should  be  provided  with  good,  attractive  quarters  where  they  can 
work,  study,  and  enjoy  themselves.  These,  however,  should  not  be  too 
palatial,  but  should  possess  home  comforts. 


650  HOSPITAL  COMMITTEE 

Dormitories 

Male  and  female  help  should,  I  believe,  be  provided  with  single  rooms, 
however  small.  A  room  no  larger  than  7  feet  by  10  feet  would  be  vastly 
better  than  sleeping  in  a  large  dormitory  full  of  uncongenial  people.  The 
help,  too,  should  have  some  place  for  sitting,  reading,  and  recreation;  for, 
unless  they  can  secure  entertainment  within  a  building  they  may  seek  it 
outside  at  some  worse  place. 

The  only  help's  quarters  at  Sea  View  Hospital,  as  yet,  are  those  in  the 
Nurses'  Home,  for  help  working  in  the  Home.  These  consist  practically 
of  cubicles  located  in  the  attic,  a  few  lighted  by  outside  windows,  but  most 
of  them  by  overhead  skylights.  It  is  a  very  economical  arrangement,  but 
can  hardly  help  being  cramped  and  hot  in  summer. 

The  best  dormitories  seen  were  those  at  Metropolitan  Hospital.  The 
building  for  male  help  will  have  some  open  dormitory  rooms,  which  the 
Superintendent  thinks  are  better  for  some  of  the  men  employed  than  in- 
dividual rooms.  For  women,  he  believes  in  individual  rooms.  The  female 
dormitory  is  a  very  commodious  one,  with  large  bedrooms,  sitting  rooms, 
and  accommodations  about  as  good  as  those  of  an  ordinary  nurses'  home. 
This  may  be  going  too  far  toward  the  other  extreme. 

The  dormitory  for  males  at  Bellevue  Hospital  was  originally  designed 
to  have  nothing  less  than  2  beds  in  a  room ;  but,  not  being  full,  a  number  of 
the  best  grade  of  employees,  such  as  clerks,  etc.,  have  single  rooms  to  them- 
selves. The  other  rooms  contain  from  2  to  5  beds.  This  doubling  up 
of  employees  is  said  to  be  unsatisfactory,  and  to  cause  dissatisfaction 
or  dissensions  which  result  in  men  leaving  the  service.  The  desire  of  the 
architects  to  have  the  floors  in  this  building  of  the  same  height  as  in  all  the 
other  buildings  has  led  to  the  extreme  height  of  floors  already  mentioned 
in  connection  with  ward  pavilions.  No  dormitory  needs  a  floor  18  feet  6 
inches  high,  or  even  15  feet,  as  the  majority  of  them  are;  a  height  of  even 
9  feet  6  inches  being  sufiicient.  If  the  architectural  lines  of  the  other 
buildings  had  not  been  followed,  and  one  or  two  more  floors  had  been 
put  into  the  present  building,  it  seems  probable  that  every  man  could  have 
been  given  a  single  room,  at  very  little  extra  expense  and  without  in- 
creasing the  dimensions  of  the  building.  No  economy  was  practiced  in 
furnishing  space  for  recreation,  to  which  the  roof  floor  and  the  basement 
are  given  over,  with  a  bowling  alley  in  the  sub-basement.  If  some  of  this 
space  had  been  put  into  single  rooms  it  might  have  gone  farther  in  making 
the  employees  satisfied.  The  toilet  facilities,  though  well  located  and  ar- 
ranged, are  fewer  for  the  number  of  beds  than  in  any  other  dormitory 
visited.  Like  the  other  new  Bellevue  buildings,  the  wooden  trim  is  un- 
necessarily heavy. 

Administration  Unit 

While  I  have  mentioned  the  units  in  order  of  importance  from  the 
patient's  standpoint,  the  administration  is,  of  course,  the  center  around 
which  all  of  this  machinery  revolves ;  and  while  it  is  one  of  the  last  build- 
ings to  be  built,  it  is  all  important  in  its  place  in  the  group. 

The  Massachusetts  General  Hospital,  built  100  years  ago,  is  just  about 
to  have  its  administration  building,  so  that  it  is  possible  to  conduct  the 
administrative  office  in  the  ward  or  other  units. 

In  the  smaller  institutions  of  from  200  to  500  beds  the  administrative 
building  often  contains  the  superintendent's  residence,  the  staff  house,  and 


CHARACTER  AND   COSTS   OF  BUILDINGS  651 

some  of  the  other  departments;  such  as  the  pharmacy,  the  Rontgen  ray 
department,  the  admitting  unit,  etc.  This  building  should,  therefore,  be 
central,  and  should  contain,  besides  the  superintendent's  offices,  space  for 
bookkeeper,  stenographer,  and  record  rooms. 

The  only  very  recently  built  administration  building  found  was  that  at 
Sea  View  Hospital.  This  is  centrally  located  and  very  elaborately  planned 
— indeed,  too  elaborately  planned.  The  2  extensive  suites  of  examination 
rooms,  for  women  and  for  men,  would  seem  designed  more  for  an  acute 
hospital  in  a  city,  where  patients  are  arriving  in  large  numbers,  than  for 
an  institution  for  the  treatment  of  tuberculosis.  The  more  logical  place  for 
elaborate  examinations  would  also  appear  to  be  in  the  City,  before  the 
patients  are  shipped  for  the  long  trip  to  Sea  View. 

Plumbing 

Hospital  plumbing,  so  far  as  the  pipes,  drains,  and  vents  are  concerned, 
is  no  different  from  that  for  any  other  building  of  like  grade,  but  the  fix- 
tures should  be  designed  or  selected  for  the  purpose  for  which  they  are  to 
be  used.  As  far  as  possible  these  fixtures  should  stand  clear  of  the  walls, 
for  two  reasons :  to  facilitate  cleaning,  and  prevent  vermin.  For,  if  the 
wall  immediately  behind  the  fixture  is  protected  with  tile,  even  though  the 
adjoining  surface  be  plaster,  the  ill  effects  of  spattering  will  not  be  serious. 

The  traps,  if  set  high  near  the  fixture,  can  readily  be  cleaned  to  the 
water  line,  if  the  strainer  is  made  removable.  This  prevents  the  accumula- 
tion of  filth  in  the  pipes. 

Bathtubs,  when  used  for  patients,  should  be  set  up  from  the  floor,  for 
two  reasons :  to  facilitate  cleaning  underneath,  and  to  permit  ease  of  bath- 
ing if  performed  by  nurse  or  attendant.  The  inlets  should  be  large,  allow- 
ing the  full  discharge  of  hot  and  cold  water  at  the  same  time.  The  type 
of  inlet  used  on  the  ocean  steamships  allows  of  quick  filling.  The  over- 
flow, if  any  (and  I  question  the  need  of  an  overflow  if  the  bath  is  given  by 
an  intelligent  attendant),  should  be  easily  cleaned.  A  plug  or  standpipe 
should  be  used,  and  not  a  "flow  back"  form  of  concealed  standpipe. 

It  is  my  belief  that  the  only  way  to  be  sure  that  a  patient  is  thoroughly 
bathed  is  to  use  a  bathing  slab  or  shallow  tub  set  high  and  used  merely  as  a 
drain  for  the  water.  Then  use  a  hose  spray  and  actually  wash  the  patient 
in  clean  running  water.  All  of  the  dirt  then  goes  directly  to  the  drain  and 
is  not  diluted  and  then  used  again  on  the  body.  This  form  of  washing  slab 
should  be  used  in  admitting  patients,  particularly  in  the  contagious  and 
children's  departments.  In  many  of  the  German  and  Austrian  hospitals  this 
form  is  used  in  the  women's  hospitals  entirely. 

In  bathing  children  with  a  spray,  it  should  be  made  impossible  for  the 
water  to  flow  too  hot  through  the  spray ;  for  a  baby,  unlike  a  grown  person, 
may  not  give  warning  of  being  scalded. 

Where  a  portable  tub  is  needed  an  improvement  can  be  made  over  the 
ordinary  tub  on  wheels,  which  is  heavy,  clumsy,  and  too  low.  A  much  more 
convenient  arrangement  is  a  light  copper  tub,  only  a  few  inches  deep, 
mounted  on  a  wheel  stretcher  frame.  If  used  in  an  isolation  room,  where 
running  water  and  a  floor  outlet  are  provided,  the  patient  could  be  bathed 
by  a  spray  at  the  end  of  a  hose  attached  to  a  faucet,  while  the  waste  water 
could  reach  the  floor  outlet  through  another  hose. 

Many  of  the  so-called  "clinic"  hoppers  are  simply  a  complicated  mass  of 
valves,  pedals,  and  sprays,  which  would  need  a  mechanician  to  operate  and 


6S2  HOSPITAL   COMMITTEE 

keep  in  order.  The  simpler  the  fixture  the  more  eflfectual.  If  a  sterilizing 
hopper  is  wanted,  one  should  be  secured  in  which  all  of  the  contents  are 
sterilized,  and  which  can  be  easily  cleaned  and  repaired. 

A  sufficient  number  of  wash  basins  should  be  placed  in  the  ward,  or  in 
the  corridor  near  the  wards,  and  in  private  rooms,  for  the  use  of  the  sur- 
geon in  scrubbing  up  before  and  after  examination.  This  is  one  of  the 
greatest  safeguards  against  cross  infection. 

The  surgeons'  operating  scrub-up  bowls  or  sinks  have  undergone  many- 
transitions  during  the  past  few  years,  and  have  passed  from  the  complicated 
pedal  valve,  through  the  less  complicated  knee  valve,  to  the  absolutely  simple 
elbow  valve  and  spray.  For  the  surgeon  who  scrubs  under  the  running 
water,  only  a  spillway  is  needed,  and  in  some  of  the  finer  European  hos- 
pitals a  hard  marble  trough  is  used.  The  valves  should  be  solid  and  easy 
working. 

The  new  water  closet,  hung  from  the  wall,  is  (where  construction  will 
permit)  a  great  improvement.  This  type  is  being  used  in  many  institutions. 
The  seats  are  an  important  item ;  if  covered  with  celluloid  and  cut  away  in 
front  they  are  much  easier  to  clean. 

For  flushing  purposes  the  flushing  valve  is  coming  into  greater  favor, 
but  is  more  likely  to  get  out  of  order  than  a  regular  tank ;  and  its  installation 
should  be  adopted  with  some  hesitation  unless  a  competent  man  is  always 
available  for  repair  work.  The  porcelain  low  tank  appears  to  be  the  most 
satisfactory  kind  for  flushing  closets,  being  the  most  reliable  and  accessible 
device. 

For  the  finish  of  plumbing  pipes,  every  part  requiring  polishing  should 
be  reduced  to  a  minimum;  for  the  care  of  brasswork  in  some  institutions 
is  quite  an  item  of  expense.  For  connections  between  fixtures  and  soil 
pipes,  rough  brass  castings  have  been  found  satisfactory,  as  they  can  be 
painted  with  aluminum  paint. 

The  plumbing  of  an  institution  should  be  standardized  as  far  as  possible, 
and  the  use  of  too  many  special  types  avoided. 

The  plumbing  seen  in  the  buildings  visited  does  not,  as  a  whole,  come 
up  to  these  standards,  although  there  were  exceptions  where  excellent  ideas 
had  been  introduced.  As  properly  designed  fixtures  cost  but  little,  if  any, 
more  than  those  in  stock,  it  would  seem  well  to  give  more  attention  to  such 
an  important  detail. 

Heating  and  Ventilating 

The  much  discussed  problem  of  how  to  properly  heat  and  ventilate  a 
hospital  building  or  the  ward  units  of  a  hospital  has  still  many  unsettled 
points :  whether  we  should  conduct  the  air  to  the  ground  floor,  heat  the 
same,  send  it  through  the  building  warmed,  washed,  and  humidified,  and 
forced  into  the  closed  room  under  thermostatic  control  at  a  given  tempera- 
ture night  and  day,  a  system  the  perfect  working  of  which  necessitates  the 
closing  of  all  windows  and  doors ;  or  whether  the  better  system  is  the  simple 
form  of  putting  the  heating  units  in  the  room  and  introducing  the  air 
directly  below  or,  as  in  the  new  General  Hospital  at  Vienna,  directly  above 
the  radiator.  With  the  latter  system,  the  opening  of  windows  improves 
rather  than  defeats  the  results.  It  is  my  belief,  borne  out  by  many  medical 
men.  that  the  patient  in  bed  should  not  have  a  high  degree  of  temperature 
in  the  room  except  in  special  cases,  and  that  nature  calls  for  changes  in 
temperature.  The  man  in  robust  health  demands  it.  Why  should  the 
patient  who  is  building  up  his  strength  be  denied  it? 


CHARACTER  AND  COSTS  OF  BUILDINGS  653 

The  ventilation  of  the  ward  or  room  is  important.  The  breathed  air 
should  be  exhausted,  and  the  means  for  ventilation  so  located  as  to  ensure 
the  complete  circulation  of  air.  If  the  room  is  large,  the  vents  should  be  at 
top  and  bottom,  with  a  damper,  so  that  the  air  can  be  drawn  from  one  or 
the  other. 

The  vent  ducts  should  start  at  the  floor,  extending  the  floor  material  to 
the  back  of  the  flue,  or  the  bottom  of  the  flue  should  be  curved  so  that  no 
dust  would  remain.    In  no  case  should  register  faces  be  used. 

Except  in  special  cases,  no  rooms  where  patients  are  in  bed  should  be 
heated  above  68  degrees  in  winter  weather. 

As  the  New  York  buildings  were  visited  in  summer  it  was  impossible 
to  judge  the  results  of  existing  heating  and  ventilating  methods;  but  in  no 
place  did  the  methods,  as  far  as  seen,  appear  ideal,  although  some  of  the 
buildings  had  good  details,  as  in  the  type  of  radiator  used  and  the  openings 
of  the  vent  ducts. 

Hospital  Details 

The  exterior  details  of  the  hospital  should  be  made  to  conform  to  the 
style  of  architecture  in  which  the  building  is  designed  and  should  be  left 
to  the  architect,  it  being  borne  in  mind  that  the  detail  and  exterior  decora- 
tion should  be  subservient  to  the  plan.  In  other  words,  the  exterior  should 
be  designed  around  the  plan  and  not  the  plan  made  to  suit  the  elevation, 
which  is  so  often  the  case.  Care,  however,  should  be  exercised  to  establish 
units  in  the  planning;  to  have  the  plumbing  of  one  story  come  near  the 
plumbing  of  the  others,  and  to  have  the  partitions  continuous. 

The  "trim"  of  the  windows  and  doors  in  the  patients'  quarters  should 
have  much  thought,  to  avoid  projecting  surfaces  and  so  facilitate  the  clean- 
ing of  the  rooms.  If  the  door  jambs  are  made  of  pressed  steel  to  the  suit- 
able form,  with  corners  rounded  and  set  to  form  a  ground  for  the  plaster, 
there  will  be  no  projection.  To  avoid  the  usual  sharp  angles  at  the  juncture 
of  the  door  jamb  and  floor  the  door  stop  should  be  omitted  for  a  few 
inches  from  the  floor  and  the  coved  base  allowed  to  run  through  the  jamb. 

The  base  can  be  made  of  the  same  material  as  the  jamb,  coved,  and 
brought  out  to  meet  the  floor;  or  the  base  may  be  of  marble,  terrazzo,  or 
other  enduring  material.  If  a  slight  projection  3  or  4  inches  from  the  wall 
is  made  in  the  floor  part  of  the  base,  a  furniture  stop  should  be  provided 
which  will  keep  the  wall  free  from  damage  by  furniture. 

It  is  my  opinion  that  the  use  of  transoms  over  doors  should  be  limited 
to  utility  rooms,  but  if  used  in  wards  the  panels  should  be  solid  and  not 
glazed,  as  glazed  transoms  allow  the  lighting  of  the  corridors  to  disturb 
the  patients  at  night.  Where  transoms  are  used  the  projecting  transom 
rail  should  be  avoided,  and  a  rail  the  thickness  of  the  sash  supplied. 

The  windows  should  be  placed  low,  so  that  the  patient  in  bed  can 
readily  see  out. 

A  simple  system  of  introducing  fresh  air  into  the  ward  is  to  provide  a 
"ventilating  apron"  at  the  lower  part  of  the  window,  allowing  air  to  enter, 
but  without  draught. 

The  doors  should  be  smooth,  without  mouldings,  and  no  thresholds 
should  be  permitted.  All  angles,  whether  floor,  wall,  or  ceiling,  should  be 
coved. 

The  walls  back  of  all  plumbing  fixtures  should  be  tiled,  with  tile  on  the 
same  surface  and  even  with  the  plaster.    The  walls  of  the  toilet  and  sink 


654  HOSPITAL   COMMITTEE 

rooms,  the  serving  kitchens  and  laboratories,  and  similar  rooms  subject  to 
much  use  should  be  tiled  to  a  height  of  5  feet. 

The  details  of  such  fixed  equipment  as  linen  closets,  serving  kitchen 
cases,  etc.,  should  be  so  constructed  as  to  leave  a  free  space  behind  all  cases. 
The  linen  cases  should  have  open  shelves,  and  be  so  built  that  they  can  be 
removed  for  cleaning. 

Serving  kitchen  and  sink  room  cases  should  have  slanting  tops,  so  that 
any  dust  that  may  be  seen  may  be  readily  removed. 

The  medicine  closets  for  each  ward  unit,  if  built  into  the  wall,  should 
have  no  reentering  angle;  should  be  tiled  about  the  sink  and  slab;  and 
should  have  artificial  lighting,  with  shelves  of  plate  glass  or  metal. 

If  clothes  closets  are  provided  for  the  private  rooms  or  wards  they 
should  be  built  with  the  same  care  that  is  suggested  for  the  medicine  closets. 
I  have  found  that  by  placing  the  vent  for  the  private  room  in  the  ceiling  of 
the  closet  and  cutting  the  bottom  of  the  door  2  inches  short,  the  ventilation 
of  the  room  as  well  as  of  the  closet  is  accomplished. 


Elevators 

Elevators  should  be  provided  where  buildings  are  more  than  2  stories 
in  height.  Where  there  are  comparatively  few  to  use  the  elevator  the  auto- 
matic type  saves  the  expense  of  an  operator,  and  it  may  be  operated  with 
perfect  safety  by  patients  or  attendants. 

In  many  of  the  ward  units  and  the  nurses'  residences  of  the  various  de- 
partments the  automatic  elevator  could  be  substituted  without  any  attendant 
danger. 

The  details  of  the  elevator  should  be  carried  out  on  hygienic  lines,  and 
it  should  be  made  of  sufficient  size  to  carry  a  bed  with  a  patient,  with 
plenty  of  room  for  nurses  and  attendants. 

The  elevators  at  Sea  View  and  Bellevue  have  already  been  criticized; 
Sea  View  for  having  too  many,  Bellevue  for  not  having  enough.  A  more 
extended  use  of  the  automatic  type  is  suggested. 


Equipment 

The  equipment  of  the  general  hospital  is  fraught  with  nearly  as  many 
perplexities  as  the  planning  of  the  buildings.  The  question  of  the  best  bed, 
the  best  food  wagon,  the  best  wheel  stretcher  or  operating  table,  is  con- 
stantly met.  I  know  of  no  general  rule  to  apply,  except  this,  that  the  simpler 
the  lines  that  will  accomplish  the  purpose,  the  better  the  equipment.  The 
requirements  of  beds  alone  are  legion.  A  bed  should  be  comfortable  for 
the  patient ;  should  be  the  right  height  to  make  the  work  easy  for  the  nurse ; 
should  be  on  large  casters  at  the  head  and  provided  with  an  adjustable  bed 
truck  at  the  foot ;  and  with  extension  legs  to  allow  for  raising  the  bed  with- 
out blocks.  If  the  bars  at  the  head  are  put  in  horizontally  instead  of  ver- 
tically they  serve  for  mild  exercise  bars  for  the  patient. 

I  have  found  in  my  own  practice  that  the  general  dealer  in  supplies 
tries  to  sell  the  wares  he  has  in  stock  and  is  not  anxious  to  have  special  de- 
signs carried  out.  I  have  also  found  that  in  order  to  get  the  best  results  it 
is  necessary  to  have  special  work  for  special  uses.  The  greater  part  of  the 
equipment  can  be  standardized,  but  much  improvement  can  be  made  on  the 
present  standard  which  is  being  used. 


CHARACTER  AND   COSTS   OF  BUILDINGS  655 

Grounds 

While  the  wards  should  be  made  homelike,  with  studied  artistic  effect 
of  wall  coloring — the  roof  ward  giving  the  freshness  of  out-of-doors — the 
grounds  about  the  institution  should  have  much  study;  for  in  the  warmer 
season  many  of  the  patients  can  be  about  the  grounds.  These  grounds 
should  be  laid  out  with  paths  and  walks,  arbors  and  shrubbery,  with  seats 
and  canopies,  and  an  occasional  fountain ;  for  the  pleasant  environment  of 
an  institution  has  its  therapeutic  effect  upon  the  patients.  The  green  grass 
and  shrubs  largely  prevent  dust  from  reaching  the  patients.  Comfort- 
able seats  and  walks  keep  the  patients  out  of  doors;  so  that  the  money 
expended  upon  the  grounds  to  make  for  the  comfort  of  the  patients  hastens 
convalescence,  and  therefore  saves  the  institution  money  in  the  end. 

Conclusions 

In  this  hurried  report,  I  have  been  able  to  merely  touch  on  some  of  the 
principal  points  to  be  considered  in  the  planning  for  the  housing  of  the  sick. 
To  make  a  comprehensive  report  of  the  conditions  of  all  of  the  buildings 
which  house  the  20,000  or  more  under  the  charge  of  the  Departments  of 
Charities,  Health,  and  Bellevue  and  Allied  Hospitals  would  take  months. 

It  would  seem,  however,  that  in  planning  for  future  enlargement  of  the 
hospital  system  for  the  City  of  New  York,  the  islands,  and  not  the  mainland, 
should  be  considered;  and  that  numerous  relief  stations  should  be  estab- 
lished in  different  sections  of  the  City  for  emergency  work,  in  connection 
with  dispensaries  and  milk  stations. 

I  wish  to  acknowledge  the  courtesy  of  Dr.  Fitzgerald  of  the  Charities 
Department,  and  of  the  Superintendents  of  City,  Metropolitan,  and  Kings 
County  Hospitals,  of  Dr.  Wilson  of  the  Health  Department,  and  Dr.  O'Han- 
lon  of  Bellevue  Hospital,  in  accompanying  me  on  my  brief  inspection  of 
the  various  buildings. 

Respectfully  submitted, 

Edward  F.  Stevens. 


THE  INVESTIGATION 

BY 

John  P.  Fox 

Methods  Used  in  Figuring  Costs 

The  figures  of  cost  have  been  obtained,  whenever  possible,  from  official 
sources,  from  the  Comptroller's  office,  and  the  records  of  the  different  de- 
partments. In  the  case  of  unfinished  buildings,  contracts  and  bids  have 
been  used  as  the  basis  of  estimating  costs.  The  figures  of  cost  of  some  of 
the  buildings  have  been  obtained  from  the  architects  of  the  buildings. 

What  the  Cost  Includes 

The  figures  showing  the  cost  of  each  building  represent  the  cost  of  con- 
struction and  fixed  equipment,  such  equipment  as  is  usually  included  by 
architects.     Architect's  fees  are  not  included  as  part  of  the  cost. 

Cost  per  Cubic  Foot 

The  most  common  basis  for  judging  the  cost  of  a  building  is  the  cost 
per  cubic  foot.  This  is  obtained  by  dividing  the  total  cost  by  the  number 
of  cubic  feet  enclosed  by  the  outer  surfaces  of  the  building,  including  all 
projecting  spaces,  such  as  steps,  porches,  penthouses,  etc.,  but  not  including 
purely  ornamental  projections,  like  cornices,  parapets  above  the  roof,  or 
chimneys. 

There  is  no  uniform  practice  among  architects  as  to  including  or  exclud- 
ing minor  projections  when  figuring  cubic  foot  costs.  Where  a  building  has 
a  number  of  open  porches  or  balconies,  and  the  air  space  enclosed  by  these 
is  included  in  the  cubic  contents  of  a  building  without  any  allowance  for 
their  lower  cost,  the  result  is  obviously  to  reduce  the  average  cost  per  cubic 
foot  of  the  building,  and  if  two  buildings  are  compared  in  cost,  one  with 
considerable  porch  or  balcony  projection  and  another  with  little  or  none, 
the  former  will  obviously  make  the  better  showing  as  to  cost  per  cubic  foot. 

In  order  to  treat  all  buildings  alike  and  make  the  cost  figures  comparable 
the  cubic  contents  of  all  projecting  spaces  have  been  estimated  on  a  basis  of 
a  representative  proportion  of  the  cost  per  cubic  foot  of  the  building.  For 
example,  where  a  porch  was  of  wood,  with  wooden  floor  and  roof,  only  25 
per  cent,  of  the  space  enclosed  was  taken  in  determining  the  cost  per  cubic 
foot.  Where  a  porch  or  balcony  was  of  fireproof  construction  but  de- 
tached from  a  building  and  open  on  all  sides,  it  was  rated  at  50  per  cent, 
of  its  cubic  contents.  This  percentage  has  been  checked  up  with  the  actual 
cost  of  balcony  construction  and  found  to  give  approximately  correct  results 
as  to  cost.  Steps,  terraces,  and  other  projections  have  been  similarly 
treated,  so  as  to  give  comparable  figures  on  the  whole  building. 

Where  a  porch  or  balcony  was  substantially  a  part  of  the  main  building, 
of  equally  heavy  construction,  and  especially  where  enclosed  with  windows, 

657 


658  HOSPITAL   COMMITTEE 

it  has  been  treated  as  a  part  of  the  main  building.  The  same  rules  have 
been  applied  to  projections  on  the  roof. 

The  height  of  a  building  has  been  measured  from  the  under  side  of  the 
basement  floor  to  the  mean  height  of  the  roof,  whether  flat  or  sloping. 
Foundations  have  not  been  included,  because  they  vary  so  much  in  depth 
and  character.  Allovi'ance  has  been  made  in  every  case  for  basement  floors 
excavated  to  diflr'erent  depths  at  different  points.  Indeed,  in  almost  every 
case,  the  cubic  contents  of  each  floor  of  a  building  have  been  determined 
separately,  instead  of  taking  the  mass  of  a  building  as  a  whole. 

In  getting  at  the  figures  for  cubic  contents  the  architect's  drawings  have 
been  used  in  all  cases,  except  occasionally  where  the  architect's  own  figures 
have  been  used  for  some  minor  building,  and  the  measurements  of  the 
buildings  have  been  carefully  taken,  so  as  to  make  the  results  as  accurate 
as  possible. 

It  was  hoped  to  be  able  to  subdivide  the  cost  per  cubic  foot  for  each 
building  into  the  different  items  which  make  up  the  cost,  such  as  founda- 
tions, iron  and  steel,  concrete,  terra  cotta,  etc.,  so  as  to  show  where  the  cost 
of  a  building  was  high  or  low,  and  what  details  of  construction  chiefly 
brought  about  the  high  or  low  cost.  It  was  found,  however,  that  the  details 
making  up  the  total  costs  of  buildings  could  not  always  be  obtained,  and 
that,  where  available,  they  were  generally  prepared  by  the  contractor  simply 
as  rough  estimates  for  the  purpose  of  assisting  the  architect  to  determine 
the  amount  of  partial  payments  due  from  time  to  time  as  the  building  was 
being  constructed. 

Cost  per  Square  Foot 

Within  certain  limitations,  the  cost  of  buildings  per  square  foot  of  floor 
area  has  a  value.  If  a  building  has  a  large  balcony  area,  and  this  area  is 
included  in  the  floor  area,  it  reduces  the  square  foot  cost,  while  the  omission 
of  all  balconies  would  run  up  the  cost  per  square  foot  of  buildings  having 
them.  The  area  was  taken  inclusive  of  the  walls  in  every  case,  and  in- 
cluded basement  area,  floor  area,  and  area  of  balconies,  porches,  and  pro- 
jections, but  only  when  these  were  covered.  That  is,  the  area  of  each  suc- 
cessive balcony  having  another  floor  or  roof  above  was  included  at  each 
floor  level.  In  the  case  of  roofs,  only  such  areas  of  a  flat  roof  were  taken  as 
were  enclosed,  and  such  penthouses  as  had  a  substantial  roof  over  them,  as 
in  the  case  of  some  roof  wards  and  roof  gardens. 

Comparative  Tables 

In  order  to  show  some  of  the  elements  which  affect  the  cost  of  build- 
ings a  series  of  comparative  tables  has  been  prepared,  in  which  recent 
buildings  have  been  grouped  according  to  types.  The  groups  are  composed 
of :  nurses'  homes,  dormitories,  tuberculosis  pavilions,  and  ward  buildings. 
These  tables  accompany  this  part  of  the  Report  on  pages  679  to  682. 

In  the  tables  there  are  given  for  each  building,  in  addition  to  various 
cost  figures,  some  of  the  principal  facts  affecting  the  cost  of  the  building, 
as  well  as  the  service  and  accommodations,  such  as  the  materials  used :  bed 
capacity ;  square  feet  of  floor  space  per  bed ;  cubic  feet  of  space  per  bed ; 
areas  of  different  rooms  used  for  different  purposes;  heights  of  floors; 
number  of  bedrooms  and  beds  in  each ;  data  in  regard  to  wards ;  size  of 
typical  rooms  or  wards;  and  plumbing  fixtures. 


CHARACTER   AND   COSTS   OF  BUILDINGS 


Square  Feet  and  Cubic  Feet  per  Bed 


659 


Two  figures  were  worked  out  for  each  building,  which  summarize  to  a 
considerable  extent  the  relative  economy  in  planning  the  buildings  used  for 
one  purpose;  viz.,  square  feet  of  floor  area  per  bed,  and  the  cubic  feet  of 
space  per  bed.  The  square  feet  and  cubic  feet  figures  were  the  same  as 
those  used  in  working  out  the  cost  for  each  of  these  items,  including  walls, 
balconies,  etc.,  as  already  explained. 

The  square  feet  per  bed  shows  whether  the  floor  space  has  been  eco- 
nomically used;  while  the  cubic  feet  per  bed  adds  the  element  of  height. 
If  the  floor  space  is  unnecessarily  large  and  the  height  of  floors  is  unneces- 
sarily great,  then  the  cubic  feet  of  space  per  bed  shows  tlie  combined  effect 
of  uneconomical  planning. 

In  comparing  the  homes  for  nurses  the  areas  devoted  to  purposes  other 
than  bedrooms  have  been  divided  by  the  proposed  number  of  nurses,  in 
order  to  make  a  comparative  showing  of  the  accommodations  for  instruc- 
tion, recreation,  etc. 

Cost  per  Bed 

The  most  important  figure  for  comparing  the  cost  of  similar  buildings  is 
naturally  the  cost  per  bed;  for  the  bed  is  the  unit  of  the  hospital.  All  the 
elements  afifecting  the  cost  in  a  building  are  combined  in  this  figure. 

In  estimating  the  bed  capacity  of  different  buildings  the  original  plans 
have  been  followed  as  far  as  possible ;  that  is,  the  capacity  represents  the 
number  of  beds  actually  planned  for  when  the  building  was  built,  and  not 
the  number  of  beds  found  in  use  to-day.  This  going  back  to  the  original 
capacity  was  found  necessary  in  order  to  make  comparisons  practicable ;  for 
some  buildings  have  had  to  have  more  beds  placed  in  them  than  they  were 
designed  for,  while  others  have  less  beds,  the  pressure  for  space  not  being 
so  great. 

Standards  for  Comparisons 

While  the  different  buildings  of  one  type  can  be  compared  with  each 
other  to  determine  which  are  satisfactory  and  which  are  not,  it  seemed 
better  to  avoid  comparisons  as  far  as  possible,  especially  between  buildings 
of  different  departments.  Instead,  standards  have  been  selected  for  each 
type  of  building.  These  standards  represent  existing  buildings,  or  buildings 
in  course  of  erection,  or  about  to  be  erected,  which  seemed  to  be  satisfac- 
tory and  economical ;  some  of  these  are  within  and  some  outside  the  City. 

In  making  comparisons  with  the  standards  the  aim  has  been,  not  to 
criticize  existing  buildings  merely  for  the  sake  of  criticism,  but  simply  to 
bring  out  facts  of  value  for  planning  future  buildings. 

Nurses'  Homes 
The  Standard 

A  nurses'  home  which  suggested  very  satisfactory  standards  in  regard 
to  space  and  the  necessary  provisions  in  a  home  was  found  in  a  city  near 
New  York.  The  building  is  under  construction  to-day,  and  represents  the 
latest  ideas  in  practical  hospital  planning.  It  is  a  fireproof  structure,  with 
terra  cotta  walls  and  concrete  floors  and  roof,  built  to  accommodate  73 
nurses,  with  provisions  for  enlargement.  The  basement  is  well  above 
ground,  and  is  adapted  for  dining  room,  kitchen,  and  storerooms.    An  ele- 


66o  HOSPITAL   COMMITTEE 

vator  connects  all  floors  with  the  basement.  The  first  floor  has  a  compact 
entrance  hall,  with  window  seat  in  alcove ;  2  small  reception  rooms ;  a  large 
library  and  lecture  room  combined,  adapted  for  recreation;  and  a  small  tea 
room  for  serving  refreshments.  On  each  floor  is  an  attractive  study  or 
sewing  room,  with  a  fireplace  at  one  end.  These  rooms,  used  for  recep- 
tion, sitting,  and  recreation  purposes,  are  termed  the  general  rooms,  and  the 
combined  floor  area  devoted  to  them  will  serve  as  one  basis  of  comparison. 

The  total  floor  area  of  these  general  rooms  amounts  to  31  square  feet 
per  nurse,  and  the  provisions  appear  to  be  liberal  without  being  extravagant. 

For  the  teaching  of  nurses  2  rooms  are  often  provided — a  class  room 
and  an  instruction  kitchen.  Sometimes  the  class  room  work  is  done  in  the 
largest  general  room  of  a  home ;  whether  it  is  a  library,  assembly  room  or 
recreation  room.  In  the  nurses'  home  used  as  a  basis  for  a  standard  part 
of  the  library  is  used  for  class  room  work,  affording  an  area  of  about  5 
square  feet  per  nurse.  If  desirable  to  have  a  separate  room,  5  square  feet 
per  nurse  appears  to  be  sufficient,  and,  also,  5  square  feet,  or  even  less,  for 
an  instruction  kitchen.  For  ordinary  teaching  purposes,  then,  10  square 
feet  per  nurse  would  appear  sufficient.  If  teaching  is  done  in  the  library, 
the  total  area  for  general  rooms  could  be  reduced  by  5  square  feet  to  26 
square  feet  per  nurse. 

A  comfortable  but  compact  dining  room  requires  from  16  to  18  square 
feet  of  floor  area  per  person  seated.  It  is  hardly  necessary,  however,  to 
provide  enough  room  for  every  nurse  to  be  seated  at  the  same  time,  for 
such  is  contrary  to  practice.  As  a  reasonable  allowance  it  has  been  sug- 
gested that  provision  be  made  for  one-half  of  the  nurses  at  one  time,  plus 
an  additional  allowance  of  25  per  cent.  This  would  require  62j^  per  cent. 
of  18  feet,  or  II  square  feet  per  nurse.  If  other  nurses  than  those  living 
in  the  building  are  to  be  served  in  the  dining  room  of  the  home  additional 
space  will  be  required. 

Kitchens  vary  greatly  in  size,  but  a  generous  allowance  would  be  18 
square  feet  per  nurse,  though  in  some  nurses'  homes  about  half  of  this 
area  has  been  found  to  be  sufficient.  This  allowance  would  include  pantry, 
serving  room,  help's  dining  room,  and  storage  space  immediately  adjoining 
the  kitchen. 

Each  nurse  has  a  single  room  in  the  standard  home,  a  provision  which 
is  now  considered  a  necessity.  There  is  also  in  each  room  a  closet,  lighted 
by  a  window,  and  a  set  basin,  with  hot  and  cold  water.  Each  room,  includ- 
ing the  closet,  is  8  feet  6  inches  by  13  feet,  which  has  been  found  large 
enough,  though  a  minimum  size  of  8  feet  by  12  feet  is  sometimes  used. 
Each  room  has  no  square  feet  of  floor  area,  including  the  closet.  With  a 
ceiling  height  of  8  feet  6  inches,  which  appears  ample,  the  room  contains 
935  cubic  feet. 

The  bathing  facilities  consist  of  3  tubs  and  i  shower  on  each  floor,  or  i 
to  every  6  nurses.    There  is  also  i  water  closet  to  every  6  nurses. 

There  are  2  substantial  airing  balconies  on  each  end  of  the  building, 
and  the  flat  roof  is  covered  in  the  center  with  a  shelter  large  enough  to 
allow  the  nurses  to  sleep  out  of  doors.  Such  a  flat  roof  is  very  desirable, 
and  is  decidedly  preferable  to  a  sloping  roof.  It  permits  rooms  on  the  upper 
floor  unrestricted  in  size,  shape,  light,  and  air,  as  well  as  the  use  of  the  roof 
for  airing  or  sleeping  purposes. 

On  the  upper  floor  is  an  infirmary  with  4  patients'  rooms,  a  diet  kitchen, 
sink  room,  toilet,  and  linen  cupboard,  with  a  total  floor  area,  including 
corridor,  amounting  to  11  square  feet  per  nurse. 


CHARACTER   AND   COSTS   OF  BUILDINGS  66l 

For  heights  of  rooms,  8  feet  6  inches  seems  ample  for  bedrooms.  Con- 
crete floors  are  now  constructed  with  a  thickness  of  12  inches,  so  that  a 
height  from  floor  to  floor  of  9  feet  6  inches  is  practicable.  For  kitchen, 
dining  room,  and  general  rooms,  a  greater  height  is  desirable;  but  it  seenis 
hardly  necessary  to  have  the  average  floor  height  exceed  10  feet. 

Between  the  ceiling  of  the  upper  floor  and  the  roof  considerable  waste 
space  is  often  found,  due  to  the  desire  of  the  architect  to  get  an  impressive 
exterior  design.  An  attractive  building  can  be  obtained  without  such 
sacrifice  of  economy,  but  a  certain  amount  of  space  at  this  point  can 
well  be  used  for  ventilating  ducts.  In  the  nurses'  home  which  serves  as  a 
standard  the  space  between  the  ceiling  of  the  upper  floor  and  the  roof  is 
2  feet  6  inches. 

The  floor  area  of  the  building,  including  the  airing  balconies  and  the 
covered  roof  garden,  amounts  to  420  square  feet  per  nurse.  The  cubic 
space  of  the  building  is  4,280  cubic  feet  per  nurse. 

As  to  cost,  the  Department  of  Public  Charities  has  had  two  nurses' 
homes  built  recently  for  29  and  31  cents  a  cubic  foot,  respectively,  the  latter 
being  on  Randall's  Island,  a  place  difficult  of  access.  The  same  Depart- 
ment is  getting  similar  buildings  constructed  for  even  a  lower  figure.  So 
that  30  cents  per  cubic  foot,  which  is  the  cost  figure  of  this  building 
adopted  as  a  standard,  appears  reasonable.  There  may  be  reasons  why  it 
should  be  exceeded  in  the  future,  such  as  increases  in  prices  of  materials 
and  labor,  expensive  foundations,  and  remote  sites,  but  allowance  can  be 
made  for  such  factors  in  determining  whether  or  not  the  cost  of  a  pro- 
posed nurses'  home  is  reasonable. 

With  a  cost  of  30  cents  per  cubic  foot,  and  an  allowance  of  4,280  cubic 
feet  per  nurse,  the  cost  per  nurse  would  be  $1,284;  ^nd  with  an  allowance 
of  420  square  feet  of  building  per  nurse,  the  cost  per  square  foot  would 
be  $3.06. 

Nurses'  Home,  Riverside  Hospital 
Department  of  Health 

This  is  next  to  having  been  the  least  expensive  of  the  nurses'  homes 
studied,  the  cost  per  nurse  having  been  $1,643,  compared  with  the  standard 
cost  of  $1,284  per  nurse,  or  about  28  per  cent.  more.  The  figures  for  the 
building  include  both  the  original  building,  begun  in  1903,  and  the  addition 
which  is  now  nearing  completion. 

The  excess  of  the  cost  above  that  of  the  standard  can  be  explained  in 
several  ways.  The  bids  were  high  for  the  original  building,  the  cost  per 
cubic  foot  having  been  39  cents,  compared  with  33  cents  for  the  addition. 
Making  allowance  for  the  location  of  the  building,  the  latter  figure  of  33 
cents  corresponds  exactly  with  the  standard  cost  of  30  cents.  The  architect 
has  found  that  construction  on  North  Brother  Island  costs  about  10  per 
cent,  more  than  on  the  mainland,  because  all  the  workmen  and  materials 
have  to  be  transported  across  the  water.  Were  it  not  for  the  fact  that  the 
high  cost  of  the  original  building  naturally  tends  to  oflrset  the  low  cost  of  the 
addition  the  cost  would  be  very  near  that  of  the  standard. 

In  the  allowance  of  area  per  bed,  in  the  building  as  a  whole,  443  square 
feet  is  only  slightly  above  the  standard  of  420  square  feet.  The  area  for 
general  rooms  is  considerably  below  that  in  the  standard,  26  square  feet  in 
this  building,  compared  with  41  square  feet  in  the  latter,  while  the  dining 
room  and  the  kitchen  allowances  are  much  less.    The  height  of  the  floors, 


662  HOSPITAL   COMMITTEE 

10  feet  2  inches,  is  a  little  greater  than  needed,  and  the  nurses'  rooms  are 
slightly  larger  than  really  necessary,  these  two  items  causing  the  excess  of 
space  over  that  in  the  standard.    Each  nurse  has  a  room  to  herself. 

The  toilet  facilities,  except  in  the  number  of  water  closets,  are  less  than 
those  of  the  standard,  there  being  no  set  basins  in  the  bedrooms.  This 
would  tend  to  reduce  the  cost  of  the  building. 


Nurses'  Home,  Kingston  Avenue  Hospital 
Department  of  Health 

In  the  matter  of  the  cost  per  nurse  this  was  the  least  expensive  of  all 
the  nurses'  homes  studied,  the  cost  having  been  $1,190  per  bed,  com- 
pared with  the  standard  of  $1,284,  or  about  7  per  cent.  less.  Two-thirds 
of  this  building  was  built  in  1904  and  the  remainder  2  years  later,  but  in 
this  case  the  addition  was  more  expensive  than  the  original  building,  the 
original  having  cost  32  cents  per  cubic  foot,  compared  with  40  cents  for 
the  addition. 

The  allowance  of  general  rooms  per  nurse  is  about  the  same  as  that  in 
the  standard,  but  the  dining  room  area  is  only  about  62  per  cent,  of  that  in 
the  standard.  The  kitchen  allowance  per  nurse  is  about  44  per  cent,  of 
that  in  the  standard. 

The  height  of  floors  is  slightly  greater  than  in  the  standard,  but  this 
tendency  toward  increased  space  is  more  than  offset  by  other  elements. 
Probably  the  chief  factor  in  lowering  the  space  allowance  is  the  provision 
for  2  nurses  in  a  room  in  32  per  cent,  of  the  rooms,  the  building  as  planned 
having  47  single  rooms  and  22  so-called  double  rooms.  And  while  the 
single  bedrooms  are  ample  in  size,  in  fact  slightly  larger  than  in  the  stand- 
ard, the  pairing  of  the  occupants  of  the  double  rooms  causes  this  home  to 
have  a  much  smaller  allowance  of  space  per  bed  than  any  of  the  other  homes 
compared,  the  square  foot  area  in  this  home  being  3,450,  as  compared  with 
4,280  in  the  standard.  However,  it  is  true  that  some  of  the  other  homes 
have  none  but  singly  occupied  rooms,  and  none  have  so  large  a  percentage 
of  double  rooms. 

The  toilet  facilities,  with  no  set  basins  in  any  of  the  bedrooms,  are 
fewer  than  in  the  standard,  and,  as  a  whole,  less  than  in  any  other  home 
studied.  The  low  cost  per  nurse  was  due  to  the  insufficient  number  of 
toilet  facilities  and  also  the  housing  of  2  nurses  in  a  room  in  a  large  per- 
centage of  the  rooms. 

Nurses'  Home,  Metropolitan  Hospital 
Department  of  Public  Charities 

Judged  by  the  cost  per  bed  this  was  the  most  expensive  home  studied, 
having  been  $2,157  per  bed,  as  compared  with  the  standard  of  $1,284,  an 
excess  of  about  68  per  cent.  In  arriving  at  these  figures,  and  also  the  al- 
lowance of  space  in  the  difl!^erent  parts  of  the  building,  the  number  of  help 
sleeping  in  the  attic  was  included  in  the  calculation. 

In  getting  at  the  reasons  for  the  high  cost  of  this  home  the  first  thing 
noticed  was  the  high  cost  per  cubic  foot,  about  40  cents.  This  may  be  partly 
accounted  for  by  the  remoteness  of  the  site,  which  is  on  the  extreme  north 
end  of  Blackwell's  Island,  although  other  stone  buildings  in  the  same  hos- 
pital group  have  cost  but  31  and  32  cents  per  cubic  foot. 


CHARACTER   AND   COSTS   OF   BUILDINGS  663 

As  found  to-day,  the  allowance  of  area  per  nurse  or  per  bed  in  all  the 
rooms  is  more  than  that  in  the  standard,  the  kitchen  alone  excepted.  This 
will  be  partly  equalized  if  the  building  be  enlarged  to  accommodate  more 
nurses.  It  would  have  been  more  economical  to  have  so  planned  the  build- 
ing that  the  common  rooms  would  have  been  in  proper  proportion  to  the 
nurses  actually  provided  for,  with  plans  for  enlargement  of  the  common 
rooms  if  wings  were  subsequently  added. 

The  floor  area  per  nurse,  523  square  feet,  is  much  larger  than  in  either 
of  the  other  homes  mentioned,  and  is  about  25  per  cent,  larger  than  in  the 
standard.  The  height  of  the  floors  is  exceeded  only  by  that  in  one  other 
home,  which,  with  the  exceptionally  large  entrance  hall,  the  library,  and 
sitting  rooms  on  3  floors  account  for  the  larger  allowance  of  floor  space 
in  this  Home.    The  lecture  room  and  instruction  room  are  generous  in  size. 

This  btiilding  provides  5,430  cubic  feet  per  nurse,  as  compared  with 
4,280  in  the  standard.  Single  rooms,  considerably  larger  than  in  the  stand- 
ard, have  been  provided  for  the  nurses,  but  they  contain  no  wash  basins,  and 
those  provided  in  the  general  toilet  rooms  are  at  the  rate  of  i  basin  to 
every  3J^  beds.  The  standard  provides  a  basin  in  every  room.  The  gen- 
eral toilet  facilities  are  about  the  same  as  in  the  standard. 


Nurses'  Home  and  Help  Quarters,  Sea  View  Hospital 
Department  of  Public  Charities 

The  cost  per  bed  of  this  building  was  exceeded  by  that  of  but  one  other 
among  the  homes  studied,  and  was  about  42  per  cent,  higher  than  that  of 
the  standard.  The  cost  per  cubic  foot,  about  45  cents,  is  a  very  high  figure, 
but  a  somewhat  higher  cost  is  to  be  expected  at  a  site  so  remote  from  trans- 
portation lines. 

The  general  capacity  is  rated  at  4,050  cubic  feet  per  bed,  as  compared 
with  4,280  cubic  feet  in  the  standard.  This  small  space  allowance  is  secured 
by  a  sacrifice  of  general  rooms  and  an  excess  space  in  the  bedrooms.  For 
the  nurses'  general  rooms  there  is  a  reception  room,  a  writing  room,  and  a 
large  recreation  room,  all  on  the  ground  floor.  There  is  no  large  reception 
hall,  as  at  Metropolitan  Hospital,  and  no  sitting  rooms  on  the  other  floors. 
The  teaching  rooms  consist  of  a  class  room  and  teaching  kitchen.  The 
dining  room  is  a  little  larger  than  in  the  standard,  seating  about  75  per  cent. 
of  the  nurses  at  one  time. 

The  kitchen  space  is  just  a  little  more  than  that  in  the  standard,  while 
the  infirmary  space  is  exactly  the  same.  The  height  of  the  floors  is  moder- 
ate, though  a  little  higher  than  in  the  standard,  except  in  the  attic,  where 
it  is  the  same  as  that  in  the  standard. 

The  single  nurses'  rooms,  which  comprise  100  of  the  107  nurses'  rooms, 
are  much  larger  in  area  than  in  the  standard,  although  narrower  and  longer. 
But  the  extra  space  in  the  rooms  is  offset  by  unusually  narrow  corridors. 

The  compactness  of  the  help's  quarters  probably  also  contributes  in 
bringing  the  square  foot  area  and  cubic  foot  space  per  bed  below  that  in 
the  standard.  The  help  sleep  in  16  single  rooms  or  cubicles  in  the  attic, 
only  5  of  which  have  outside  windows.  The  remaining  11  are  lighted  by 
skylights  in  the  roof,  the  partitions  reaching  to  about  13  inches  below  the 
ceiling.  The  largest  room  shown  on  the  plans  has  an  area  of  about  98 
square  feet  of  floor  space ;  the  next  largest  room  has  63  square  feet ;  and  7 
rooms  have  an  area  of  only  59^^  square  feet. 


664  HOSPITAL   COMMITTEE 

The  toilet  facilities  for  the  nurses  seem  to  be  sufficient,  except  perhaps 
on  the  attic  floor.  There  are  9  bathtubs  and  6  showers  in  the  general  toilet 
rooms  for  the  nurses.  These,  taken  together,  are  slightly  less  than  in  the 
suggested  standard;  but  there  are  more  water  closets  than  in  the  standard, 
and  any  lack  of  tubs  and  showers  is  offset  by  the  furnishing  of  a  set  basin 
in  every  nurse's  room. 


Nurses'  Home,  Kings  Coimty  Hospital 
Department  of  Public  Charities 

The  cost  per  bed  of  this  Home  was  about  36  per  cent,  more  than  that 
of  the  standard,  due  to  a  liberal  allowance  of  space  in  a  number  of  ways. 
The  square  foot  allowance  of  area  per  bed  is  not  so  much  in  excess  of  that 
in  the  standard  as  is  the  cubic  feet  of  space  per  bed,  which  is  the  largest  of 
any  of  the  homes,  due  to  a  greater  height  of  floors  than  in  any  of  the  other 
homes  compared. 

The  cost  per  cubic  foot,  29  cents,  was  lower  than  that  of  any  of  the 
other  homes.  From  this,  one  might  expect  a  cheaply  planned  and  con- 
structed building;  but  on  inspection  quite  the  opposite  appeared  to  be  the 
case.  The  building  is  very  handsome  inside ;  in  good  condition  ;  and  no  poor 
construction  is  noticeable. 

The  number  and  size  of  the  general  rooms,  as  well  as  the  considerable 
height  of  the  floors  already  mentioned,  are  probably  the  chief  causes  for  the 
high  cost  per  bed  of  the  building.  On  the  first  floor  there  are  a  large  en- 
trance hall,  2  reception  rooms,  and  a  large  library,  with  a  sitting  room  on 
each  of  the  3  bedroom  floors  above;  while  the  fifth  floor  has  another  very 
handsome,  domed  sitting  room,  with  a  large  gymnasium.  The  floor  area  of 
all  these  rooms  now  amounts  to  about  54  square  feet  per  nurse,  but  when 
two  wings  are  added  to  the  building,  as  provided  in  the  plans,  this  area  of 
general  rooms  will  be  reduced  to  about  35  square  feet  per  nurse,  which, 
however,  will  be  4  square  feet  more  than  in  the  standard. 

The  area  of  the  teaching  rooms  is  very  large,  and,  with  the  wings  added, 
will  still  be  more  than  that  in  the  standard.  There  are  3  teaching  rooms  on 
the  first  floor,  called  demonstration  class,  study  class,  and  lecture  rooms. 
The  area  of  the  dining  room  at  present  exceeds  that  in  the  standard,  but  its 
proportion  to  the  whole  will  be  less  when  the  wings  are  added.  The 
kitchen  and  serving  room  area  is  now  less  than  in  the  standard,  and  the 
infirmary,  though  at  present  larger,  will  be  the  same  as  that  in  the  standard 
when  the  building  is  extended. 

The  floors  have  the  greatest  height  of  any  of  the  homes,  the  first  floor 
being  over  15  feet  high  and  the  fourth  floor  14  feet  in  height.  The  heights 
are  evidently  due  to  a  desire  for  architectural  efifect,  especially  in  the  ex- 
terior of  the  building.  This  extra  height  accounts,  in  a  large  measure,  for 
the  high  cost  per  nurse,  $1,747,  as  compared  with  $1,284  for  the  standard. 

The  nurses'  and  help's  rooms  are  all  single.  The  smallest  of  the  nurses' 
rooms  have  the  least  square  feet  of  area  of  any  compared,  but  almost  equal 
that  of  the  standard,  and  are  large  enough.  The  closets  are  arranged  be- 
tween every  2  rooms,  instead  of  at  the  end  nearest  the  door,  an  arrange- 
ment which  uses  more  building  space  than  the  end  closets. 

The  number  of  bathtubs,  showers,  and  water  closets  is  larger  than  the 
standard,  and  there  is  a  set  basin  in  every  nurse's  bedroom,  the  same  as  in 
the  standard  home. 


CHARACTER  AND   COSTS   OP  BUILDINGS  665 

Nurses'  Home,  Children's  Hospitals,  Randall's  Island 
Department  of  Public  Charities 

This  building  has  about  the  same  square  foot  area  and  cubic  foot  space 
allowance  per  bed  as  the  Nurses'  Home  of  Metropolitan  Hospital.  The 
cost  per  bed  was  about  34  per  cent,  higher  than  that  of  the  standard,  while 
the  cost  per  cubic  foot  of  30>4  cents  was  close  to  the  standard  of  30  cents, 
and  very  low,  considering  the  inaccessible  location  on  Randall's   Island. 

The  floor  areas  of  the  different  kinds  of  rooms  per  nurse  or  per  bed  are, 
in  some  cases,  close  to  those  in  the  standard,  and  in  other  cases  greatly 
exceed  it.  The  teaching  and  infirmary  areas  are  more  than  double  those  in 
the  standard.  The  general  rooms  and  kitchen  nearly  equal  those  in  the 
standard;  while  the  dining  room  is  64  per  cent,  larger. 

When  the  Home  is  increased  to  its  full  size  the  dining  room  space  will 
be  exactly  the  same  as  in  the  standard;  that  of  the  general  rooms  and 
kitchens  less ;  but  the  teaching  and  infirmary  space  will  still  be  considerably 
in  excess.  It  is  well  to  repeat  here  the  statement  that  when  possible  the 
common  rooms  should  be  adjusted  to  the  number  of  nurses  provided  for, 
and  the  building  so  planned  that  these  common  rooms  can  be  enlarged  with 
any  increase  in  the  number  of  rooms  for  nurses.  The  unnecessarily  large 
common  rooms  add  to  the  original  cost  of  the  building,  the  subsequent  up- 
keep, and  lessen  the  bed  capacity. 

The  height  of  the  lower  floors,  though  exceeded  in  only  two  other  build- 
ings, is  greater  than  in  the  standard.  The  nurses'  rooms,  with  closets  be- 
tween, use  more  space  than  necessary,  though  this  is  offset  by  the  arrange- 
rnent  of  4  rooms  for  2  nurses  each.  Two  of  the  help's  rooms  also  provide 
for  2  tenants  in  each.  The  rooms  for  the  latter  have  the  closets  at  the  in- 
side end,  with  the  most  economical  arrangement  of  space. 

Nurses'  Home,  Fordham  Hospital 
Bellevue  and  Allied  Hospitals 

The  cost  of  this  building  could  not  be  determined  from  the  figures  ob- 
tained, for  only  the  cost  of  the  entire  Hospital  was  found.  The  cubic  feet  of 
space  per  nurse  is  moderately  excessive,  being  about  13  per  cent,  more  than 
in  the  standard. 

The  floor  areas  of  the  different  groups  of  rooms  were  found  to  very 
nearly  coincide  with  those  in  the  standard,  except  for  the  general  rooms, 
which  are  about  26  per  cent,  larger.  These  include  a  large  library,  recep- 
tion room,  and  i  sitting  room  for  the  4  floors.  The  height  of  floors  is  mod- 
erate, though  not  as  low  as  in  the  standard. 

The  somewhat  square  shape  and  considerable  depth  of  the  building  do 
not  lend  themselves  to  an  economical  size  of  bedrooms,  the  smallest  of 
which  has  the  largest  area  of  any  of  the  minimum  sized  nurses'  rooms  in 
the  homes  compared.  Six  of  the  bedrooms  were  designed  for  2  beds  and 
I  for  3  beds. 

The  toilet  facilities  are  ample,  except  that  there  are  no  set  basins  in  the 
bedrooms,  though  there  is  i  for  every  3  nurses  in  the  toilet  rooms,  but 
otherwise  they  equal  those  in  the  standard. 


666  HOSPITAL   COMMITTEE 

Nurses'  Home,  Greenpoint  Hospital 
Department  of  Public  Charities 

This  building  has  been  planned  but  not  yet  built,  so  that  the  cost  figures 
are  not  obtainable.  However,  the  main  building  of  the  Hospital  now  under 
construction  is  costing  only  263-!  cents  per  cubic  foot. 

This  Home  differs  radically  from  those  already  considered,  in  that  it 
contains  only  bedrooms  and  sitting  rooms ;  the  cooking  being  done  in  the 
main  kitchen  of  the  Hospital,  where  the  assembly,  class,  and  dining  rooms 
are  located.  The  allowances  of  floor  area  for  the  general,  teaching,  and 
dining  rooms  are  very  large,  compared  with  those  in  the  standard.  For 
general  and  teaching  purposes,  taken  together,  the  floor  area  is  almost 
double  that  in  the  standard  home,  and  the  dining  room  area  is  exactly 
double  that  in  the  standard. 

The  height  of  ceiling  in  all  the  bedrooms  is  10  feet  6  inches,  instead 
of  an  average  of  9  feet  and  a  minimum  of  8  feet  6  inches  as  suggested  in 
the  standard.  The  area  of  the  bedrooms  is  slightly  above  that  of  the  rooms 
in  the  standard,  though  their  cubic  feet  of  space  is  much  more,  owing  to  the 
high  ceilings.  The  toilet  accommodations  are  fewer  than  those  of  the 
standard  in  the  matter  of  baths ;  more  in  the  number  of  water  closets,  and 
identical  in  the  matter  of  wash  basins. 


Dormitories 
The  Standard 

There  is  a  wide  divergence  of  views  as  to  how  dormitories  for  help 
should  be  constructed.  Some  authorities  maintain  that  it  is  not  only  unneces- 
sary to  provide  single  rooms  for  the  help,  but  that  it  is  wiser  not  to  do  so, 
at  least  with  certain  grades  of  employees.  Others  would  give  the  help  not 
only  single  rooms,  but  practically  the  same  accommodations  as  are  provided 
for  nurses,  in  the  way  of  bed,  reception,  and  sitting  rooms,  and  toilet 
facilities. 

In  deciding  upon  a  standard  dormitory  to  show  the  proper  space  per 
bed,  the  size  of  the  rooms,  the  toilet  facilities,  and  other  requirements,  a 
mean  was  taken  between  the  two  extremes  shown  in  the  table  and  moderate 
sized  rooms  with  moderate  accompaniments  were  selected.  A  5-story  build- 
ing, providing  for  38  beds  on  a  floor,  was  planned ;  with  the  smallest 
satisfactory  single  bedrooms  and  also  with  the  largest  necessary  rooms,  and 
a  mean  was  taken  between  the  two. 

For  a  standard  bedroom,  8  feet  by  12  feet,  giving  a  floor  area  of  96 
square  feet,  seems  large  enough,  this  being  generally  regarded  as  the  mini- 
mum satisfactory  size  for  a  nurse's  room.  A  ceiling  height  of  8  feet  6 
inches  seems  sufficient,  or  9  feet  6  inches  from  floor  to  floor,  giving  816 
cubic  feet  of  space  in  a  room  of  the  dimensions  stated,  including  a  closet. 
Toilet  facilities  should  provide  a  bathtub  or  shower  for  every  8  beds ;  a 
water  closet  for  every  6  beds ;  and  a  hand  basin  for  every  4  beds. 

For  reception,  sitting,  and  recreation  rooms,  an  allowance  of  10  square 
feet  of  floor  area  per  bed  seems  sufficient,  or  about  one-third  of  the  re- 
quirement for  nurses,  for  when  help  are  given  rooms  to  themselves  it  seems 
hardly  necessary  to  furnish  so  much  space  for  general  purposes  as  when  2 
or  more  sleep  in  a  room.  Some  provision  for  sitting  out  of  doors  is  de- 
sirable ;  on  porches,  the  roof,  or  both.    Recreation  rooms  can  well  be  placed 


CHARACTER  AND   COSTS   OF  BUILDINGS  66/ 

in  the  basement,  where  ample  space  is  generally  available  and  quite  satis- 
factory for  night  use. 

The  area  and  cubic  space  of  building,  over  the  walls,  needed  for  these 
purposes  are  about  200  square  feet  per  bed  and  2,000  cubic  feet  per  bed,  re- 
spectively. For  a  standard  cost,  30  cents  per  cubic  foot  has  been  used,  the 
same  as  for  a  nurses'  home,  this  being  21,2  cents  above  the  minimum  cost  of 
the  dormitories  compared,  and  about  J^  cent  lower  than  the  Nurses'  Home 
on  Randall's  Island.  A  dormitory  should  not  be  so  elaborately  finished  nor 
contain  so  many  rooms  for  general  purposes  as  a  nurses'  home,  but,  having 
smaller  rooms,  it  would  be  more  compact,  and  so,  while  a  somewhat  similar 
cost  per  cubic  foot  could  be  expected,  the  cost  per  bed  would  be  much 
lower.  The  resulting  cost,  over  the  walls,  would  be  $600  per  bed  and  $3  per 
square  foot. 

Maids'  Dormitory,  Willard  Parker  Hospital 
Department  of  Health 

This  building  has  been  planned  but  not  yet  built.  It  will  be  5  stories 
high,  with  the  first  floor  occupied  by  an  infirmary  for  sick  maids,  matron's 
quarters,  and  temporary  rooms  for  internes.  The  other  floors  will  each 
have  2  open  dormitory  rooms,  with  38  beds  to  a  floor,  a  sitting  room,  large 
toilet  room,  and  linen  room.  The  dormitory  rooms  will  eventually  be  di- 
vided by  steel  partitions  into  spaces  for  2  beds  each,  with  closets  at  the  head 
of  each  bed. 

As  no  contracts  have  been  awarded  for  this  building  the  exact  cost  can- 
not be  stated.  When  the  last  bids  were  received  the  lowest  combined  bid 
for  construction,  heating,  and  plumbing  was  $103,227,  and  these  figures 
have  been  considered  as  representing  the  cost.  This  is  at  the  rate  of  $633 
per  bed;  $3.33  a  square  foot;  and  2754  cents  a  cubic  foot.  While  the  cost 
per  bed  is  slightly  above  that  of  the  standard,  it  would  be  lower  if  the  first 
floor  were  used  for  dormitory  rooms  and  not  for  the  infirmary,  internes, 
etc.  The  space  per  bed  would  then  be  1,975  cubic  feet,  or  practically  the 
standard  of  2,000  cubic  feet. 

This  is  interesting  because  it  shows  that  there  is  no  economy  of  space 
in  putting  several  or  even  20  beds  in  a  room,  as  was  planned  in  this  case. 
The  open  dormitory  building  may  be  somewhat  cheaper  than  the  type  with 
single  rooms,  because  of  the  absence  of  so  many  partitions  and  doors,  but 
there  is  little  saving  in  space. 

The  sitting  room  area  in  this  building  is  exactly  that  in  the  standard,  but 
the  toilet  facilities  are  less.  The  height  of  the  floors  is  much  greater  than 
necessary,  furnishing  in  the  open  dormitory  rooms  about  as  much  air  space 
as  some  authorities  consider  necessary  in  an  acute  hospital  ward.  These 
high  floors  add  considerably  to  the  cost  of  the  building. 

Maids'  Dormitory,  Riverside  Hospital 
Department  of  Health 

This  building  has  not  been  built  nor  any  contracts  awarded,  but  the 
lowest  bids  received  amount  to  $95,340,  or  $3.83  a  square  foot  and  30 
cents  per  cubic  foot.  Like  the  Maids'  Dormitory  of  Willard  Parker  Hos- 
pital, it  will  have  the  first  floor  devoted  to  an  infirmary  for  sick  maids, 
matron's  quarters,  and  rooms  for  internes.     The  other  floors  will  have  2 


668  HOSPITAL  COMMITTEE 

open  dormitory  rooms,  containing  32  beds  to  a  floor;  the  space  eventually 
to  be  divided  ofif  by  steel  partitions  into  cubicles  for  2  beds  each,  with 
closets  at  the  head  of  each  bed. 

If  the  first  floor  of  this  building  would  have  32  beds  like  the  others,  the 
cost  per  bed  would  be  reduced  to  $745,  and  the  square  foot  area  per  bed  to 
19s  square  feet,  with  2,480  cubic  feet  of  space  per  bed.  This  last  is  greater 
than  in  the  standard,  though  single  rooms  are  not  provided. 

The  area  of  sitting  rooms  is  a  little  more  than  that  in  the  standard; 
bathing  facilities  a  little  less ;  with  water  closets  and  wash  basins  just  equal 
to  those  in  the  standard. 

The  space  between  floors  is  unnecessarily  high,  this  being  one  of  the 
reasons  for  the  excessive  cubic  contents  per  bed  in  spite  of  the  arrange- 
ment of  16  beds  in  a  room. 

The  higher  probable  cost  per  cubic  foot  for  this  Dormitory  than  that 
of  Willard  Parker  Hospital  may  be  due  to  the  remoter  location,  on  North 
Brother  Island,  the  difl^erence  in  cost  between  the  two  buildings  being  12 
per  cent,  or  almost  exactly  the  increase  in  price  for  North  Brother  Island 
found  by  the  architect  of  previous  buildings  there. 


Dormitory  for  Female  Help,  Metropolitan  Hospital 
Department  of  Public  Charities 

This  building  is  used  wholly  for  dormitory  purposes,  containing  91  bed- 
rooms, of  which  83  are  single  rooms  and  8  are  double  rooms.  It  is  a  very 
commodious  building,  almost  as  much  so  as  a  nurses'  home,  and  as  a  result 
the  square  foot  area  of  building  per  bed  is  70  per  cent,  more  than  in  the 
standard,  while  the  cubic  foot  space  per  bed  is  84  per  cent.  more.  The 
cost  per  bed  was  twice  that  of  the  standard. 

The  first  floor  has  a  large  reception  hall,  with  open  fireplace;  matron's 
suite;  17  bedrooms;  2  toilets;  2  wash  rooms;  a  special  laundry  closet  with 
set  tub ;  sink  and  storage  closets.  The  floors  above  have  22  bedrooms  each, 
and  toilet  and  wash  rooms.    There  is  also  a  large  sitting  room  on  every  floor. 

The  sitting  room  area  is  slightly  less  than  in  the  standard,  and  the  toilet 
facilities  are  fewer,  except  wash  basins,  which  are  the  same  as  in  the 
standard.  The  height  of  the  floors  is  less  than  in  the  Riverside  buildings, 
but  greater  than  in  the  standard.  It  will  be  noticed  in  the  table  that  there 
is  a  space  of  from  3  to  4  feet  between  the  highest  ceiling  and  the  roof.  Be- 
sides this,  the  walls  rise  3  feet  6  inches  above  the  roof,  or,  on  the  average, 
7  feet  above  the  ceiling  of  the  fourth  floor.  This,  of  course,  was  responsible 
for  some  of  the  higher  cost  of  this  building. 

The  size  of  the  smallest  rooms  exceeds  slightly  that  in  the  standard,  the 
rooms  as  a  rule  being  large  enough  for  nurses'  rooms. 

Dormitory  for  Female  Help,  City  Hospital 
Department  of  Public  Charities 

This  building,  which  is  under  construction,  consists  principally  of  single 
bedrooms,  with  a  large  sitting  room  on  each  floor.  The  square  foot  area  of 
building  per  bed  is  75  per  cent,  more  than  in  the  standard  and  the  cubic  foot 
space  per  bed  is  about  80  per  cent,  more,  the  resulting  cost  per  bed  being 
about  90  per  cent,  more  than  that  of  the  standard.    One  reason  for  this  is 


CHARACTER   AND   COSTS  OP  BUILDINGS  669 

the  large  size  of  the  3  sitting  rooms,  each  equal  to  3  bedrooms,  amounting 
in  floor  area  to  20  square  feet  per  bed,  or  double  that  in  the  standard.  The 
toilet  facilities  are  about  the  same  as  in  the  standard. 

The  height  of  the  floors  is  lower  than  that  of  any  other  dormitory  com- 
pared, but  still  seems  higher  than  really  needed.  There  is  no  waste  space, 
however,  between  the  ceiling  of  the  upper  floor  and  the  roof. 

The  bedrooms  are  moderate  in  size,  with  just  a  little  more  floor  area 
than  in  the  standard. 


Male  Help  Building,  Greenpoint  Hospital 
Department  of  Public  Charities 

This  Dormitory  has  been  planned  but  not  built,  and  no  figures  are  avail- 
able as  to  its  probable  cost.  The  Male  Help  Building,  Female  Help  Build- 
ing, and  Nurses'  Home  at  this  Hospital  are  alike  as  to  size  of  rooms,  height 
of  floors,  toilet  accommodations,  etc. 

The  square  foot  area  per  bed  of  the  Male  Help  Building  is  about  64 
per  cent,  more  than  in  the  standard,  and  the  cubic  foot  space  per  bed  about 
106  per  cent,  m.ore.  This  last  figure  will  mean  a  high  cost  per  bed,  probably 
at  least  double  that  of  the  standard.  The  greater  excess  of  the  cubic  feet 
per  bed  over  the  square  feet  per  bed  is  due  partly  to  the  height  of  the 
floors,  but  chiefly,  no  doubt,  to  a  sloping  tile  roof,  the  top  of  which  is  12 
feet  6  inches  above  the  highest  ceiling. 

The  sitting  room  space  is  just  a  little  less  than  in  the  standard.  The 
toilet  facilities  also  are  less,  except  the  wash  basins,  of  which  there  is  i  in 
every  room.    The  bedrooms  are  all  single  and  of  large  size. 


Male  Dormitory,  Bellevue   Hospital 
Bellevue  and  Allied  Hospitals 

This  building  is  part  of  the  Pathological  Building,  and,  therefore,  its 
cost  could  not  be  separated  or  carefully  determined.  But  as  the  structure 
itself  is  about  the  same  as  the  Pathological  Building  the  cost  per  cubic  foot 
for  the  whole  building  has  been  assumed  for  the  Dormitory. 

Accommodations  were  planned  for  246  beds  on  6  floors,  in  rooms  with 
from  2  to  5  beds  each,  but  as  the  building  is  not  yet  full  some  of  the  higher 
grade  of  help,  such  as  clerks,  use  the  smaller  rooms  singly. 

The  cost  per  bed  of  this  Dormitory  was  nearly  double  that  of  the 
standard.    This  was  partly  due  to  the  high  cost  per  cubic  foot  of  41  cents. 

The  high  cost  per  cubic  foot  was  due  to  the  building's  expensive  con- 
struction and  finish.  It  is  a  high  structure  and  required  the  expense  of  a 
steel  frame. 

The  square  foot  area  per  bed  is  less  than  that  in  the  standard,  but  the 
cubic  foot  space  per  bed  is  nearly  50  per  cent,  more  than  in  the  standard. 
The  sitting  room  space  is  very  large,  nearly  double  that  in  the  standard. 
In  the  sub-basement  there  is  a  bowling  alley,  which  is  not  included  in  the 
space  as  figured,  and  in  the  basement  there  is  a  library,  smoking  room,  and 
billiard  room,  and  on  the  roof  there  are  2  sitting  rooms. 

The  toilet  facilities  are  all  much  less  than  in  the  standard.  The  height 
of  floors,  which  is  the  same  as  in  all  the  new  Bellevue  buildings,  is  espe- 
cially great  for  a  dormitory,  with  i  story  of  19  feet  8  inches,  and  the  others 


6/0  HOSPITAL   COMMITTEE 

15  feet  or  more.    This  explains  why  the  cubic  foot  space  per  bed  is  so  much 
in  excess  of  that  in  the  standard. 

The  size  of  the  smallest  room  on  each  floor,  designed  for  2  beds,  is  8 
feet  by  18  feet,  with  an  actual  floor  area  of  125  square  feet,  or  73  square 
feet  per  bed,  compared  with  the  96  square  feet  in  the  standard.  The  rooms 
for  3  beds  are  about  12  feet  by  18  feet,  with  72  square  feet  per  bed.  With 
a  13-foQt  ceiling,  the  air  space  amounts  to  946  cubic  feet  per  bed,  but  the 
higher  space  is  not  counted  as  of  value. 

Ward  Buildings 
The  Standard 

There  is  no  type  of  building  for  which  it  is  more  difficult  to  fix  a  stand- 
ard than  a  ward  building;  because  of  the  constant  improvements  in  plan 
found  desirable  by  medical  men,  or  required  by  different  conditions  and 
services.  A  tentative  standard  building  has  been  designed,  however,  to 
serve  as  a  criterion  by  which  to  form  some  judgment  as  to  the  economy  of 
the  planning  and  cost  of  existing  ward  buildings. 

In  the  standard  set  forth  in  the  table  an  allowance  of  1,200  cubic  feet 
per  bed  was  fixed  for  the  wards,  with  100  square  feet  of  floor  per  bed,  and 
a  ceiling  height  of  12  feet.  Large  wards,  containing  32  beds,  were  adopted 
in  order  to  get  economy  of  space,  while  the  requirements  of  smaller  ward 
units  were  met  by  dividing  the  wards  off  by  screens  into  4  units  of  8  beds 
each.  A  large  airing  balcony  was  provided,  and  toilets  and  utility  sinks 
placed  at  the  end  of  each  ward. 

The  administration  end  of  the  building  was  planned  to  contain:  a 
large  ward  kitchen ;  large  utility  room ;  patients'  toilet  room ;  day  room ; 
linen  room ;  bathroom,  large  enough  to  wheel  a  patient  into ;  a  room 
for  surgical  dressings  or  other  purposes ;  elevator  and  stairway ;  and  3  quiet 
rooms,  containing  5  beds  in  all.  The  flat  roof  would  have  the  same  adminis- 
tration rooms  as  the  other  floors,  with  the  ward  space  properly  open  to  the 
air. 

The  basement  was  designed  to  be  9  feet  in  height  up  to  the  first  floor, 
with  the  floors  above  13  feet  in  height,  providing  a  12-foot  ceiling. 

The  resulting  square  foot  area  per  bed  of  the  building  worked  out  at 
236  square  feet,  with  3,008  cubic  feet  of  space  per  bed. 

The  same  cost  per  cubic  foot  was  taken  as  for  dormitory  buildings ;  viz., 
30  cents.  This  may  seem  low  for  a  ward  building,  but  two  such  buildings 
have  recently  been  built  in  Brooklyn  at  a  cost  of  about  28J/2  cents  per  cubic 
foot. 

Measles  Pavilion,  Willard  Parker  Hospital 
Department  of  Health 

This  is  a  7-story,  reinforced  concrete  building,  for  the  open  air  treatment 
of  measles.  There  are  22  rooms  for  observation  purposes  on  the  first  floor, 
each  with  its  own  toilet  and  basin,  and  outside  door  opening  on  to  a  porch. 
The  floors  above  have  2  wards  each,  subdivided  down  the  center  by  a  glazed 
partition,  with  sections  to  be  opened  for  cross  ventilation,  except  when 
mixed  infection  occurs.  The  wards  are  still  further  divided  by  glass  parti- 
tions into  stalls  for  2  beds  each.  The  service  rooms  on  the  ward  floors  con- 
sist of  4  toilets,  opening  out  of  each  half  ward ;  a  kitchen ;  treatment  room ; 
3  nurses'  rooms;. a  cleaner's  closet;  and  a  linen  closet.     On  the  center  of 


CHARACTER   AND   COSTS   OF  BUILDINGS  67 1 

each  floor  there  is  a  large  day  room  and  on  the  upper  floor  there  arc  oper- 
ating rooms.  There  are  no  separate  utihty  rooms  in  connection  with  the 
wards,  all  the  necessary  work  being  done  in  the  toilet  rooms.  A  large  open 
porch  is  provided  at  each  end  of  the  building,  opening  out  of  the  4  ward 
divisions,  each  porch  containing  an  enclosed  fire  escape. 

It  may  be  judged  from  this  description  that  this  was  an  expensive  build- 
ing; due  in  a  measure  to  the  large  amount  of  subdividing  and  plumbing  re- 
quired for  the  proper  treatment  of  a  contagious  disease.  Another  reason 
for  the  high  cost  per  cubic  foot  is  that  the  location  close  to  the  East  River 
required  rather  an  expensive  foundation,  this  having  been  responsible  for 
about  10  per  cent,  of  the  cost.  A  third  feature  that  increased  the  cost 
somewhat  was  the  use  of  tiles  for  floors  throughout  the  building,  including 
the  wards,  which  also  is  considered  necessary  in  a  contagious  disease  build- 
ing, and  which  in  this  case  formed  about  5  per  cent,  of  the  cost. 

The  cost  per  cubic  foot  of  the  building  would  probably  have  been  much 
higher  had  it  not  been  built  of  reinforced  concrete,  as  it  was  estimated  that 
a  brick  building  would  cost  about  12  per  cent,  more  than  concrete.  The 
conditions  for  concrete  construction  were  very  favorable;  with  plenty  of 
ground  to  work  on  and  a  simple  architectural  design,  requiring  only  simple 
foi-ms. 

The  cost  per  bed  of  the  building  was  considerably  lower  than  that  of 
the  standard,  and  would  have  been  still  more  so  but  for  the  higher  cost  per 
cubic  foot.  There  are  a  number  of  reasons  for  this  low  cost.  As  many  of 
the  patients  will  be  children  placed  in  cribs,  a  smaller  allowance  of  space 
per  bed  was  made  than  would  be  provided  if  all  the  patients  were  to  be 
adults.  The  intention  to  keep  the  windows  open  for  open  air  treatment 
made  a  lesser  air  space  practicable  and,  as  a  result,  the  square  feet  of  floor 
area  per  bed  in  the  wards  is  about  28  per  cent,  less  than  in  the  standard 
and  the  cubic  feet  per  bed  34  per  cent.  less.  This  also  causes  a  low  figure 
for  the  square  foot  area  and  cubic  foot  space  of  building  per  bed. 

It  will  be  noticed  that  the  floor  heights  are  unusually  low  for  a  hospital, 
being  12  feet,  with  an  11 -foot  height  to  the  ceiling.  The  building  is  ex- 
tremely compact  in  every  way,  the  distance  between  the  ceiling  of  the  upper 
floor  and  the  roof  being  only  12  inches,  compared  with  a  maximum  of  6 
feet  6  inches  observed  at  Bellevue. 

In  order  to  compare  the  dififerent  ward  buildings  on  a  per  bed  basis; 
viz.,  to  compare  the  cost  per  bed,  square  foot  area  per  bed,  and  cubic  foot 
space  per  bed,  it  was  necessary  to  rate  the  capacity  of  each  building  in  beds 
on  the  same  basis.  This  was  done  by  determining  the  number  of  beds  pos- 
sible in  each  building  if  1,200  cubic  feet  of  air  space  were  required  for  each 
bed.  Using  this  as  a  basis,  the  number  of  beds  in  the  wards  of  the  Measles 
Pavilion  would  be  reduced  from  24,  as  planned,  to  14,  the  result  being  to 
make  the  cost  and  other  figures  per  bed  higher  than  those  of  the  standard. 

The  Department  of  Health  may  be  criticized  for  providing  such  a  small 
floor  area  and  air  space  per  bed;  and  doubtless  there  will  be  times  during 
the  winter,  with  the  wards  full,  when  severely  stormy  or  cold  weather  will 
interfere  with  the  open  air  idea  and  necessitate  closing  the  windows.  But, 
except  at  such  times,  the  small  allowance  of  space  per  bed  may  be  satisfac- 
tory. With  the  great  fluctuations  in  the  daily  census  of  the  Department 
of  Health  hospitals,  the  officials  certainly  have  a  problem  to  avoid  having 
buildings  larger  than  requirements  demand  during  much  of  the  year.  The 
open  air  treatment  permits  great  economy  of  space  and  the  results  of  its 
working  should  be  watched  with  great  interest. 


672  HOSPITAL   COMMITTEE 

Isolation  Pavilion,  Kingston  Avenue  Hospital 
Department  of  Health 

This  is  a  2-story  brick  building  for  the  isolation  and  observation  of 
suspicious  contagious  cases.  The  floors  are  of  concrete  and  also  the  flat 
roof.  The  first  floor  is  much  like  that  of  the  Measles  Pavilion  at  Willard 
Parker  Hospital,  with  20  self-contained  observation  rooms  along  a  central 
corridor ;  administration  rooms  in  the  center  of  the  building ;  and  a  porch 
surrounding  the  building,  upon  which  each  isolation  room  opens  by  a  door. 
There  is  no  stairway  inside  the  building  to  the  second  story. 

The  second  floor  has  2  large  wards,  44  feet  by  30  feet,  with  administra- 
tion rooms  in  the  center,  consisting  of  kitchen,  nurses'  room,  bathrooms, 
lavatories,  and  storeroom.  At  each  end  of  the  wards  is  a  treatment  room, 
and  a  room  for  admission  and  discharge,  with  bath.  The  second  story  is 
reached  only  by  stairways  at  each  end  of  the  building,  connected  with 
completely  enclosed  porches.  The  wards  will  hold  36  cribs  each  if  arranged 
in  4  rows  with  2  down  the  center.  The  floors  are  moderate  in  height,  the 
first  floor  having  an  ii-foot  ceiling  and  the  second  a  12-foot  ceiling,  the 
same  as  in  the  standard. 

The  cost  of  this  building  per  cubic  foot,  though  11  per  cent,  more  than 
that  of  the  standard,  is  considerably  less  than  that  of  the  Measles  Pavilion  at 
Willard  Parker,  largely  for  two  reasons :  the  foundations  were  simple  com- 
pared with  those  of  the  Measles  Pavilion;  and  the  contractor  is  said  to 
have  made  a  mistake  in  estimating.  The  finish  of  the  building  is  more  ex- 
pensive than  in  the  Measles  Pavilion.  Marble  has  been  used  for  the  floor 
base,  all  the  floors  are  tile,  and  all  the  woodwork  is  metal  covered.  Con- 
sidering that  the  building  was  built  of  brick  instead  of  concrete  and  that 
the  finish  is  of  such  an  expensive  character,  it  would  seem  that  the  cost  was 
low. 

The  cost  per  bed  was  the  lowest  of  all  ward  buildings  studied,  the  rea- 
son being  very  clear  on  looking  at  the  square  foot  area  and  cubic  foot  space 
per  bed  in  the  wards ;  namely,  37  square  feet  and  438  cubic  feet,  or  only  a 
little  over  a  third  of  the  space  in  the  standard.  The  capacity  of  the  wards 
is  based  on  the  number  of  cribs  they  can  hold,  not  beds.  The  number  of 
beds  possible  would  be  only  half  the  number  of  cribs,  or  even  less. 

The  bed  capacity  of  the  wards,  allowing  1,200  cubic  feet  per  bed,  is  13 
beds,  instead  of  36  cribs.  This  raises  all  the  figures  of  cost  and  space  per 
bed,  the  cost  being  about  50  per  cent,  more  than  that  of  the  standard. 

Pavilions  A  and  B,  BeUevue  Hospital 
Bellevue  and  Allied  Hospitals 

The  first  ward  building  of  the  new  Bellevue  buildings  is  a  brick  and 
steel  structure,  with  steel  and  concrete  floor,  7  stories  high.  The  first  floor 
was  originally  designed  for  5  small  children's  wards  and  i  large  medical 
ward,  with  about  17  other  rooms  mostly  for  administrative  purposes.  The 
three  sides  of  the  building  form  a  court  enclosed  on  the  fourth  side  by  a 
loggia,  and  balconies  have  been  added  on  each  side  of  each  ward  wing.  The 
6  floors  above  the  first  have  2  large  wards  each,  holding  24  beds  each,  and 
17  or  18  other  rooms,  such  as  a  convalescent  ward,  quiet  rooms,  and  the 
usual  utility  rooms,  toilets,  kitchens,  bathrooms,  linen  rooms,  etc.  The 
number  of  beds  on  each  floor  as  planned  is  56  or  57.  A  teaching  room  was 
also  planned  for  each  floor,  with  coat  room  and  laboratory  in  connection 


CHARACTER  AND  COSTS   OF  BUILDINGS  673 

with  it,  and  roof  wards  liave  been  added  since  the  building  was  built.  One 
stairway  and  one  elevator  serve  the  entire  building. 

The  floor  heights  are  about  the  same  as  in  all  of  the  new  Bellevue  build- 
ings, the  only  variations  being  in  the  heights  of  the  cellar  and  roof  struc- 
tures. The  ground  floor  is  15  feet  high;  the  next  floor  is  18  feet  6  inches; 
the  next  15  feet  8  inches;  and  the  floors  above  15  feet.  The  height  of  ceil- 
ings ranges  from  about  13  feet  to  15  feet  9  inches.  Between  the  ceihng  of 
the  upper  floor  and  the  level  of  the  flat  roof  is  a  space  of  about  6  feet  6 
inches. 

The  cost  per  cubic  foot  of  this  building  was  the  highest  of  all  ward 
buildings  compared.  There  are  many  reasons  for  this :  the  foundations 
were  of  a  very  expensive  character,  the  building  being  directly  on  the  edge 
of  the  East  River;  the  steel  frame  and  concrete  were  more  expensive  than 
reinforced  concrete  would  have  been ;  and  the  finish  of  the  building  was  ex- 
pensive, the  woodwork  being  heavy  and  much  of  the  trim  unnecessary;  and 
the  corridors  and  various  utility  rooms  have  expensive  tile  floors  and 
tile  base. 

The  cost  per  bed  of  the  building  was  more  than  double  that  of  the  stand- 
ard. The  high  cost  per  cubic  foot  accounts  for  part  of  the  difference,  and 
the  rest  of  the  excess  is  due  to  the  large  amount  of  floor  area  and  air  space 
provided  per  bed.  In  the  lowest  wards  there  are  117  square  feet  of  area 
and  1,523  cubic  feet  of  air  space  per  bed,  and  in  the  highest  wards  the  air 
space  is  1,850  cubic  feet  per  bed. 

If  more  beds  were  placed  in  the  wards  and  advantage  taken  of  the  large 
air  space,  the  cost  per  bed  could  be  materially  reduced.  Allowing  1,200 
cubic  feet  of  space  per  bed  the  wards  would  hold  30  beds  instead  of  24,  and 
the  total  capacity  of  the  building  would  be  increased  25  per  cent.  The  cost 
per  bed  would  also  be  reduced  17^^  per  cent. 

Pavilions  L  and  M,  Bellevue  Hospital 
Bellevue  and  Allied  Hospitals 

The  second  ward  building  of  the  new  Bellevue  buildings  is  the  same  as 
the  first;  as  to  construction,  materials,  and  general  dimensions.  The  floor 
plans  are  about  the  same  in  the  provision  for  wards,  but  the  arrangement 
of  the  other  rooms  has  been  greatly  changed  and  improved  under  Dr.  Gold- 
water's  direction.  The  balconies  and  roof  wards  have  been  included  in  the 
original  construction. 

From  the  point  of  view  of  cost  Pavilions  L  and  M  make  a  better  show- 
ing than  A  and  B.  The  cost  per  cubic  foot  is  about  12  per  cent,  less,  though 
it  is  still  23  per  cent,  more  than  that  of  the  standard ;  the  expensive  founda- 
tions account  for  19  per  cent,  of  this  excess.  The  finish  of  the  buildings  is 
not  materially  different;  the  same  kind  of  heavy  wooden  trim  has  been  put 
in  and  also  tile  floors,  though  in  the  wards  plastic  linoleum  has  been  laid  in- 
stead of  wood  as  in  A  and  B. 

While  the  cost  per  cubic  foot  is  12  per  cent,  less  than  in  the  other  pa- 
vilions, the  cost  per  bed  is  only  7  per  cent.  less.  Pavilions  L  and  M  are 
slightly  larger  than  A  and  B  and  the  number  of  beds  planned  for  has  been 
increased  to  2  more  in  each  ward,  making  a  maximum  increase  of  6  on  a 
floor. 

If  1,200  cubic  feet  were  allowed  for  each  bed  the  wards  would  each 
hold  30  beds  instead  of  26  as  planned,  making  an  increase  of  56  beds  in  the 
building.    This  would  reduce  the  cost  per  bed  considerably,  but  this  cost 


674  HOSPITAL  COMMITTEE 

would  be  almost  the  same  as  for  A  and  B ;  for  if  space  in  A  and  B  were 
wholly  utilized  the  higher  cost  per  cubic  foot  as  compared  with  L  and  M 
would  be  almost  entirely  neutralized  by  the  greater  square  foot  area  and 
cubic  foot  space  per  bed  of  L  and  M. 

New  Ward  Wing,  Harlem  Hospital 
Bellevue  and  Allied  Hospitals 

The  new  ward  wing  of  Harlem  Hospital  has  been  planned  for  some 
time,  but  construction  was  delayed  because  the  first  bids  received  ex- 
ceeded the  amount  appropriated.  However,  more  money  was  appropri- 
ated and  new  bids  received,  the  lowest  estimate  being  less  than  the  lowest 
of  the  first  bids  and  well  within  the  appropriation. 

The  new  wing  is  a  brick  building,  5  stories  high,  similar  to  the  main  hos- 
pital building,  and  follows  the  lines  of  the  original  structure.  It  is  rather 
a  complicated  building  in  plan,  with  a  considerable  number  of  rooms  for 
special  purposes  and  the  basement  fully  utilized,  so  that  the  cost  of  34  cents 
per  cubic  foot  may  not  in  reality  be  high.  The  number  of  beds  is  not  as 
large  as  it  would  be  in  an  ordinary  ward  building,  which  helps  to  account 
for  the  high  cost  per  bed,  which  is  more  than  double  that  of  the  standard. 
The  small  number  of  beds  accounts  for  the  large  square  foot  area  and  cubic 
foot  space  of  building  per  bed. 

One  feature  that  increased  the  cost  unnecessarily  is  the  height  of  the 
floors,  generally  15  feet,  or  2  feet  more  than  in  the  standard. 

New  Ward  Wing,  Kings  County  Hospital 
Department  of  Public  Charities 

This  is  a  4-story  brick  building,  containing  2  large  wards  on  each  floor 
and  administration  rooms  in  the  center.  There  are  a  kitchen  and  i  utility 
room  for  both  wards  on  a  floor,  and  i  toilet  for  each  ward.  There  are  2 
quiet  rooms  with  3  beds  in  each  and  the  wards  have  22  beds  each,  or,  in  all, 
50  beds  on  a  floor.  In  an  angle  between  the  2  wards  on  3  floors  there  is  an 
enclosed  solarium,  with  doorways  opening  into  a  fire  tower,  and  at  the  west 
end  of  the  building  there  are  balconies  for  every  floor.  The  roof  has  no 
provision  as  yet  for  a  roof  ward. 

The  cost  per  bed  of  this  building  was  lower  than  that  of  any  other 
ward  building  studied,  and  5  per  cent,  lower  than  that  of  the  standard,  due 
to  the  fact  that  the  cost  per  cubic  foot  was  5  per  cent,  lower.  The  cubic 
foot  space  of  building  per  bed  is  exactly  that  of  the  standard,  while  the 
square  foot  area  per  bed  is  5  per  cent.  less. 

The  height  of  the  floors  is  slightly  more  than  in  the  standard,  but  the 
building  as  a  whole  appears  very  satisfactory  as  to  cost. 

Children's  Hospital,  Kings  County  Hospital 
Department  of  Public  Charities 

This  is  a  4-story  brick  building,  comprising  the  center  and  east  wing 
of  the  completed  structure.  The  center  pavilion  contains  small  wards  with 
windows  on  three  sides,  while  the  east  wing  has  larger  wards  with  windows 
on  four  sides.     Every  ward  opens  onto  a  balcony.     The  roof  has  a  play- 


CHARACTER  AND   COSTS   OF  BUILDINGS  675 

room  in  the  center,  but  the  rest  of  it  is  uncovered.    The  utility  and  toilet 
facilities  are  in  i  room. 

The  cost  of  this  building  per  cubic  foot  was  nearly  the  same  as  the  new 
ward  wing  at  the  same  hospital,  and  4  per  cent,  below  that  of  the  standard. 
The  square  foot  area  per  bed  is  less  than  in  the  standard,  but  the  cubic  foot 
space  is  more,  due  to  the  floors  being  higher  than  in  the  standard.  The  re- 
sulting cost  per  bed  is  ij^  per  cent,  more  than  that  of  the  standard. 

Tuberculosis  Pavilions 
Standards 

It  was  found  necessary  to  arrange  standards  for  two  types  of  buildings 
for  the  treatment  of  tuberculosis ;  for  the  incipient  and  advanced  stages,  re- 
spectively. The  four  buildings  at  North  Brother  Island  for  open  air  treat- 
ment were  classed  as  of  the  former  type,  and  the  East  and  West  Infirmaries 
at  Metropolitan  Hospital  and  the  ward  buildings  at  Sea  View  were  grouped 
as  being  of  the  advanced  stage  type.  No  study  has  been  made  of  the  build- 
ings for  the  treatment  of  incipient  cases  at  Otisville,  because  of  lack  of 
time. 

Standard  Building  for  Open  Air  Treatment 

No  building  as  yet  erected  for  the  open  air  treatment  of  tuberculosis 
seems  wholly  satisfactory  and  so  a  new  standard  was  devised,  combining 
the  best  features  of  existing  and  proposed  buildings.  Four  buildings  with 
varying  amounts  of  space  were  designed  and  the  one  which  provided  suffi- 
cient space  and  accommodations,  without  appearing  extravagant,  was  se- 
lected as  the  standard.  The  structure  was  planned  to  be  4  stories  high,  with 
40  beds  on  a  floor,  or  160  beds  in  all.  The  administration  rooms  would  be 
in  the  center,  and  the  wings  would  extend  north  and  south. 

The  plans  provide  for  a  large  recreation  room  and  storage  space  in  the 
basement.  The  other  floors  were  planned  alike,  to  have  a  stairway,  elevator, 
ward  kitchen,  and  nurses'  room  with  toilet  and  closet,  on  one  side  of  a 
center  hall ;  and  on  the  other  side  4  toilet  and  bathrooms,  each  floor  to  have 
2  tubs,  12  wash  basins,  6  water  closets,  and  2  slop  sinks.  In  order  to  en- 
courage proper  bathing  each  basin  should  be  in  a  separate  alcove,  where 
complete  privacy  could  be  had. 

A  wide  hall  would  extend  the  whole  length  of  the  building,  with  glazed 
doors  at  each  end  and  a  door  opposite  the  stairs  opening  upon  the  balconies. 
The  arrangement  of  beds  cannot  be  described  in  detail  here  because  it  is 
part  of  the  plans  of  a  tuberculosis  hospital  not  yet  built  and  the  designers 
are  not  quite  ready  to  make  the  plans  public.  The  arrangement  is  such  that 
each  patient  would  be  given  the  privacy  of  a  cubicle  opening  directly  on 
to  a  wide  balcony,  with  a  door  wide  enough  to  move  the  bed  through,  and 
a  complete  circulation  of  air  would  be  obtained  in  each  cubicle,  no  matter 
what  the  direction  of  the  wind  or  how  severe  a  storm  might  be.  The  cubi- 
cles could  all  be  connected  so  as  to  permit  passing  through  them,  or,  if  any 
patient's  condition  should  require  a  warm  room  any  one  of  the  cubicles 
could  be  closed  ofl?  from  the  rest,  making  an  isolation  room  opening  into 
the  central  hall.  The  central  hall  would  be  kept  warm,  and  small  warmed 
dressing  rooms  for  each  patient  would  be  located  close  by  each  bed.  Thus, 
in  dressing  and  in  passing  to  and  from  the  toilet  and  bathrooms  the  patients 
would  not  come  into  contact  with  a  cold  atmosphere  as  is  commonly  the 


676  HOSPITAL  COMMITTEE 

case.     The  small  dressing  rooms  would  have  sufficient  space  for  all  the 

patient's  belongings  always  close  at  hand. 

A  desirable  feature  of  such  a  tuberculosis  building  is  the  arrangement 
of  balconies  to  extend  completely  around  the  building.  This  would  afford  a 
place  to  walk  without  having  to  go  down  to  the  ground,  and  enable  patients 
to  reach  the  toilets  without  having  to  pass  through  the  building,  thus  keeping 
them  more  out  of  doors. 

For  such  a  building  a  cost  per  cubic  foot  of  30  cents  has  again  been 
taken  as  a  standard.  The  square  foot  area  per  bed  works  out  at  264  square 
feet.  This  looks  large,  but  a  portion  of  it  is  due  to  the  generous  extent  of 
the  balconies.  The  cubic  foot  space  per  bed  is  2,130  cubic  feet.  When  cor- 
rected for  the  lower  cost  of  the  balconies  the  cost  per  bed  would  be  $639. 

While  the  provisions  of  the  building  may  seem  almost  extravagant, 
the  planning  has  resulted  in  a  cost  which  is  unexpectedly  low. 

First  Tuberculosis  Pavilions,  Riverside  Hospital 
Department  of  Health 

The  tuberculosis  pavilions  of  the  Department  of  Health  on  North 
Brother  Island  are  remarkable  for  their  compactness.  There  are  four  pa- 
vilions, built  at  two  different  times,  and  all  are  of  reinforced  concrete,  4 
stories  high.  The  center  of  each  building  is  occupied  by  administration 
rooms,  with  two  wings  for  wards  extending  east  and  west.  There  are  no 
balconies,  as  the  wards  have  windows  on  three  sides,  which  are  expected  to 
give  the  patients  all  the  fresh  air  required. 

The  general  rooms  of  the  first  pavilions  consist  of  a  toilet  room  opening 
out  of  each  ward,  with  i  tub  and  i  shower  for  each  floor,  or  i  tub  or  shower 
for  every  10  patients,  compared  with  i  for  every  20  patients  in  the  standard ; 

2  basins  for  each  ward  of  10  beds,  or  5  patients  to  a  basin,  compared  with 

3  in  the  standard  building ;  i  water  closet  for  every  10  patients,  compared 
with  I  for  every  7  patients  in  the  standard.  Each  floor  also  has  a  kitchen, 
with  dumbwaiter,  and  a  nurse's  room.  On  the  other  side  there  is  a  large 
day  room,  directly  between  the  2  wards,  with  plate  glass  in  the  partitions 
to  facilitate  supervision. 

The  wards  have  a  capacity  of  10  beds  each,  and  glass  partitions  have 
been  placed  between  every  2  beds.  While  all  the  wards  are  not  yet  arranged 
this  way,  this  maximum  capacity  has  been  assumed  for  the  buildings. 

No  dressing  rooms  or  lockers  are  provided  for  the  patients  and  no  eleva- 
tor has  been  installed,  and  the  patients  at  present  go  to  an  outside  dining 
room  for  their  meals. 

The  cost  per  bed  of  the  first  two  pavilions  was  lower  than  that  of  any 
other  tuberculosis  or  ward  building  studied.  This  was  due  to  a  number  of 
causes.  The  cost  per  cubic  foot  was  a  little  higher  than  that  of  the 
standard,  chiefly  because  of  very  expensive  foundations,  and  the  location 
on  North  Brother  Island  was  another  factor.  But  this  higher  cost  has 
been  more  than  made  up  for  by  the  compactness  of  the  building.  The 
square  foot  area  and  cubic  foot  space  per  bed  are  much  less  than  in  the 
standard,  the  chief  cause  of  which  can  be  seen  in  the  ward  dimensions 
and  air  space.  The  wards  provide  71  square  feet  of  floor  per  bed,  while 
the  lowest  ward  has  588  cubic  feet  per  bed. 

This  last  figure  would  be  considered  too  low,  except  for  the  fact  that 
the  wards  are  intended  for  open  air  treatment  and  consequently  are  ex- 


CHARACTER  AND   COSTS   OF  BUILDINGS  677 

posed  to  direct  ventilation  from  the  outside.  If  the  beds  in  each  ward  were 
allowed  1,200  cubic  feet  of  space  there  would  be  only  5  beds  in  a  ward 
instead  of  10.  This,  of  course,  would  double  the  cost  per  bed  as  well  as  the 
space  per  bed. 

It  will  be  noticed  that  the  height  of  the  floors  is  unusually  low,  giving 
practically  a  9-foot  ceiling.  The  ceiling  of  the  upper  floor  is  only  8  feet 
4  inches  high,  but  this  story  was  an  afterthought,  and  has  been  made  higher 
in  the  later  pavilions. 

Second  Tuberculosis  Pavilions,  Riverside  Hospital 
Department  of  Health 

The  latest  tuberculosis  pavilions  at  North  Brother  Island  are  much  like 
the  first,  except  that  the  dimensions  have  been  increased  so  as  to  provide 
larger  wards,  a  higher  upper  floor,  and  a  better  arrangement  of  the  adminis- 
tration rooms.  These  changes  have  increased  the  square  foot  area  and 
cubic  foot  space  per  bed,  and  also  the  cost  per  cubic  foot,  the  latter  about 
14  per  cent.  The  resulting  cost  per  bed  was  slightly  higher  than  that  of  the 
standard,  but  this  can  all  be  attributed  to  the  location  and  expensive  founda- 
tions. The  square  foot  area  per  bed  and  cubic  foot  space  per  bed  are  less 
than  in  the  standard.  If  1,200  cubic  feet  of  space  were  allowed  per  bed  in 
the  wards  there  would  be  5  beds  in  a  ward  instead  of  10,  as  in  the  first 
buildings. 

Standard  Tuberculosis  Pavilion  for  Advanced  Treatment 

In  working  out  a  standard  tuberculosis  pavilion  the  lines  of  the  standard 
ward  building  were  followed  in  several  respects.  A  4-story  building  was 
planned,  with  a  large  ward  on  each  floor,  having  a  capacity  of  32  beds, 
divided  by  screens  into  units  of  8  beds  each.  100  square  feet  of  floor  were 
allowed  for  each  bed,  and  a  12-foot  ceiling  provided  1,200  cubic  feet  per 
bed.  Toilets  and  utility  sinks  were  provided  at  the  far  end  of  the  ward,  and 
wide  balconies  on  each  side,  large  enough  to  hold  all  the  beds  in  the  wards. 

The  administration  end  of  the  pavilion  would  have  a  large  ward  kitchen ; 
a  patients'  toilet  room,  with  4  basins  in  alcoves  and  4  water  closets ;  a  large 
bathroom,  into  which  a  patient  could  be  wheeled ;  locker  room,  with  locker 
for  each  patient's  belongings;  linen  room;  elevator;  stairway;  and  4  single 
quiet  rooms.  The  dimensions  of  these  rooms  would  follow  closely  those 
of  one  of  the  best  designed  tuberculosis  pavilions  in  the  country. 

The  4  floors  would  be  alike,  with  a  ward  on  the  roof.  The  whole  build- 
ing would  have  a  capacity  of  144  beds  and  the  standard  cost  would  be  30 
cents  per  cubic  foot,  as  in  the  other  standards. 

West  Tuberctilosis  Infirmary,  Metropolitan  Hospital 
Department  of  Public  Charities 

The  tuberculosis  pavilion  of  the  Metropolitan  Hospital  that  was  built 
first  is  the  West  Infirmary.  It  is  a  stone  building,  with  concrete  floors,  and 
there  are  4  wards  on  each  floor,  with  groups  of  administration  rooms  be- 
tween the  wards.  In  the  center  of  each  floor  there  are  an  examining  room, 
2  dressing  rooms,  and  a  storeroom.  At  each  end  are  the  main  administra- 
tion rooms,  each  serving  2  wards.  These  consist  of  a  lavatory,  with  6  basins 
in  alcoves ;  2  bathtubs ;  diet  kitchen,  with  dining  table ;  linen  closet ;  emer- 
gency room ;  utility  room ;  nurses'  toilet  room ;  patients'  toilet  room,  with  6 
water  closets;  stairway;  and  elevator. 


678  HOSPITAL   COMMITTEE 

The  wards  were  originally  designed  for  14  beds,  with  a  doorway  be- 
tween every  2  beds,  or  6  doors  on  each  side  of  a  ward,  giving  access  to  the 
wide  balcony  on  each  side  of  each  ward. 

The  cost  per  cubic  foot  of  the  West  Infirmary  was  about  that  of  the 
standard,  but  the  cost  per  bed  was  higher,  due  to  a  larger  square  foot  area 
and  cubic  foot  space  per  bed.  The  administration  space  is  considerably 
larger  than  in  the  standard,  and  the  space  per  bed  in  the  wards  less. 

The  height  between  floors  is  the  same  as  in  the  standard,  except  the 
height  between  the  upper  floor  and  the  roof.  This  is  18  feet  6  inches,  with 
at  least  7  feet  of  space  between  the  ceiling  of  the  upper  floor  and  the  roof. 
The  pavilions  on  North  Brother  Island  have  only  13I/2  and  13%  inches, 
respectively,  at  this  point. 

North  Wing,  East  Infirmary,  Metropolitan  Hospital 
Department  of  Public  Charities 

This  building  completes  the  East  Infirmary,  making  it  the  same  size  as 
the  West  Infirmary.  It  is  a  4-story  structure  of  stone,  with  concrete  floors, 
and  similar  to  the  north  end  of  the  West  Infirmary;  as  to  dimensions,  size 
of  wards,  balconies,  and  general  arrangements.  Changes  have  been  made 
in  the  administration  rooms,  however,  effecting  considerable  economy  of 
space  and  providing  16  more  beds  in  this  half  of  the  East  Infirmary.  The 
diet  kitchen  has  been  omitted  on  the  3  lower  floors,  because  many  of  the 
patients  go  to  the  common  dining  room.  The  space  thus  saved  has  been 
used  on  the  first  floor  for  4  isolation  rooms,  and  on  the  second  and  third 
floors  for  2  small  wards  of  6  beds  each. 

Although  the  cost  per  cubic  foot  of  this  wing  was  higher  than  that  of 
the  West  Infirmary  the  cost  per  bed  was  lower,  because  of  the  provision 
for  a  larger  number  of  beds.  The  cost  per  bed  of  this  building  was  slightly 
lower  than  that  of  the  standard. 

Pavilions  i  and  8,  Sea  View  Hospital 
Department  of  Public  Charities 

These  are  the  latest  pavilions  at  Sea  View  Hospital  and  not  yet  com- 
pleted. They  are  being  built  of  steel,  with  hollow  tile  walls  and  floors,  4  sto- 
ries high.  The  administration  end  of  each  floor  contains  a  serving  kitchen; 
nurses'  room,  with  medicine  cabinet;  utility  room;  storeroom;  isolation 
room ;  elevator ;  stairway ;  cedar  lined  linen  room ;  bathroom,  with  tub 
and  shower;  and  patients'  toilet. 

The  remainder  of  each  floor  in  both  buildings  comprises  3  wards  ex- 
tending at  right  angles  to  the  front  part  and  parallel  with  each  other,  the 
whole  in  the  form  of  the  letter  T,  the  center  ward  having  16  beds  and  the 
side  wards  6  beds  each.  On  each  side  of  the  buildings  is  a  wide  balcony, 
to  which  access  is  had  by  numerous  doors  opening  out  of  the  3  wards.  The 
roof  is  available  for  use,  having  the  necessary  administration  rooms. 

The  cost  per  cubic  foot  of  the  buildings  was  higher  than  that  of  the 
standard ;  but  this  is  not  surprising,  considering  the  inaccessibility  of  the 
site.  The  cost  per  bed  was  slightly  higher  than  that  of  the  standard,  partly 
because  of  the  higher  cost  per  cubic  foot,  as  the  square  foot  area  per  bed 
and  cubic  foot  space  per  bed  are  less  than  in  the  standard,  which  is  prob- 
ably due  to  the  fact  that  the  cubic  foot  area  per  bed  in  the  wards  is  con- 
siderably lower  than  in  the  standard.  Allowing  1,200  cubic  feet  per  bed  in 
the  3  wards  on  a  floor,  the  capacity  of  the  buildings  would  be  reduced  about 
14  per  cent.    The  height  of  floors  is  about  the  same  as  in  the  standard. 


CHARACTER  AND   COSTS   OF  BUILDINGS 


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3.  INTERNAL  CONTROL  FORMS  SUGGESTED  FOR 
BELLEVUE  HOSPITAL 


The  Need 

The  head  of  any  large  department,  establishment,  or  institution  must 
judge  of  the  efficient  operation  of  the  various  functions  under  his  control  by 
synoptical  reports  laid  before  him  at  stated  periods.  These  reports  must 
summarize  the  daily  operation  of  the  various  functions  in  such  a  way 
that  the  information  contained  therein  will  indicate  to  the  directing  head 
whether  or  not  any  particular  activity  is  being  properly  conducted.  It  is 
possible  to  report  on  almost  any  activity  in  such  a  way  that  one  familiar 
with  the  results  that  should  be  obtained  can  readily  judge  whether  or  not 
the  expected  results  are  being  secured. 

It  is  impossible  for  the  superintendent  of  an  institution  the  size  of 
Bellevue  Hospital  to  personally  supervise  daily  all  of  the  activities  of  the 
institution.  Their  direction  must  be  left  to  subordinate  heads,  and  of  these 
heads  there  are  so  many  that  if  the  superintendent  should  endeavor  to 
confer  with  each  at  frequent  intervals  his  time  would  be  almost  entirely 
occupied  with  conferences.  For  the  proper  conduct  of  the  institution  it  is 
necessary  to  have  reports  come  to  his  desk,  setting  forth  what  each  activity 
has  accomplished  within  a  stated  period,  and  setting  it  forth  in  such  a 
manner  that  the  report  will  clearly  show  whether  it  is  being  properly 
conducted. 

Such  reports  would  rarely  indicate  the  particular  thing  that  might 
be  out  of  adjustment,  but  they  would,  if  the  proper  information  were  in- 
corporated, show  that  something  was  wrong,  and  also  in  what  department 
of  the  institution  it  existed.  Having  ascertained  from  a  report  of  a  par- 
ticular activity  that  the  results  expected  were  not  being  secured,  it  would 
be  necessary  for  the  superintendent  to  call  before  him  the  head  of  that  activ- 
ity for  a  detailed  explanation  of  the  summarized  information  in  the  re- 
port. 

Even  with  the  best  of  control  reports  in  operation  it  would  be  necessary 
for  the  directing  head  to  have  periodic  conferences  with  the  heads  of  the 
various  activities  and  departments,  for  the  purpose  of  keeping  more  closely 
in  touch  with  the  work,  and  also  for  the  purpose  of  giving  directions. 
Such  conferences  are  also  useful  in  defining  the  work  of  each  department 
and  activity,  and  in  creating  a  closer  understanding  and  cooperation  between 
different  heads. 

Generally  speaking,  public  institutions  are  very  deficient  in  control 
measures  and  forms.  The  same  statement  could  have  been  made  of  busi- 
ness generally  until  within  the  last  few  years.  The  public  accountant  and 
efficiency  engineer  have  done  much  toward  systematizing  large  business 
undertakings  and  developing  forms  of  reports  and  memoranda  which  enable 
the  directing  head  to  constantly  know  the  condition  of  affairs  in  every 
branch  and  department  of  a  business.  Comparatively  little  attention  has 
been  given  to  such  matters  in  public  institutions,  and  as  a  result  they  are 
not  as  efficiently  conducted  as  private  enterprises  handling  a  corresponding 
amount  of  money. 

Bellevue  Hospital  was  selected  in  which  to  make  an  examination  of  the 
various  activities  for  the  purpose  of  determining  whether  or  not  the  con- 

685 


686  HOSPITAL  COMMITTEE 

trol  forms  used  at  present  are  adequate  and  the  organization  efficient. 
But  the  selection  was  not  made  because  it  was  assumed  that  at  the  present 
time  Bellevue  is  less  efficient  than  our  other  pubHc  institutions.  In  fact, 
it  seems  to  be  operated  with  as  great  efficiency  as  any  of  the  City's  institu- 
tions, and  much  more  ably  than  some  of  them.  Bellevue  was  chosen 
because  the  Committee  is  suggesting  a  reorganization  of  the  medical  service 
in  this  Hospital,  and  it  was  deemed  advisable  at  the  same  time  to  reorganize 
the  administrative  department  of  the  institution.  It  is  hoped,  however,  that 
the  forms  suggested  for  Bellevue  will  serve  as  a  basis  for  all  of  the  hos- 
pitals in  the  City,  with  such  modifications  as  may  be  necessary  to  adjust 
them  to  local  conditions.  In  this  connection  it  should  be  stated  that  Belle- 
vue lacks  subordinate  administrative  officers.  The  Superintendent,  without 
a  departmental  assistant,  is  supposed  to  direct  the  activities  not  only  of 
Bellevue,  but  of  three  allied  hospitals  located  in  different  parts  of  the 
City,  an  impossible  task  for  one  man  to  perform.  Associated  with  him  is 
an  Assistant  Superintendent,  whose  entire  time  is  occupied  with  the  affairs 
of  Bellevue  Hospital  alone.  Many  of  the  shortcomings  in  the  administra- 
tive department  of  Bellevue  are  due  to  the  undermanned  condition  of  the 
department. 

The  administrative  organization  of  Bellevue  and  Allied  Hospitals  may 
be  described  as  follows : 

A  Board  of  (seven)  Trustees  appointed  by  the  Mayor  has  charge  of  all 
the  affairs  of  the  allied  hospitals.  They  entrust  the  direction  to  a  Superin- 
tendent, who  supervises  not  only  Bellevue  Hospital,  but  the  three  allied 
hospitals.  The  Superintendent  has  one  assistant,  who  is  occupied  with  the 
detailed  affairs  in  Bellevue  Hospital  alone ;  in  each  of  the  allied  hospitals 
there  is  a  Superintendent;  and  associated  with  the  Superintendent  of  each 
hospital  there  is  a  Storekeeper,  who  acts  in  the  capacity  of  an  Assistant 
Superintendent.  At  Bellevue  Hospital  there  is  a  Contract  Clerk,  whose  func- 
tion is  primarily  that  of  auditor  and  bookkeeper  for  the  entire  Department. 
Associated  with  him  as  an  assistant  is  a  Purchasing  Agent,  who  purchases 
supplies  for  the  Department.  The  Purchasing  Agent,  under  the  supervision 
of  the  Contract  Clerk,  makes  all  open  order  purchases  or  contracts  for  food 
and  supplies.  The  Storekeeper  has  charge  of  the  receipt  and  distribution 
of  food  and  supplies.  The  laundry  is  in  charge  of  a  trained  nurse,  under 
whom  there  is  an  experienced  laundryman.  The  Dietitian  has  charge  of  the 
requisitions  for  the  Department  and  the  preparation  and  service  of  food 
in  Bellevue  Hospital.  A  Supervising  Engineer  has  charge  of  engineering 
matters  in  the  whole  Department,  with  an  engineer  in  charge  of  each  plant. 
One  man  has  entire  charge  of  the  ambulance  service  and  also  the  work 
about  the  grounds.  Repairs  to  the  physical  plant  are  in  charge  of  the 
Supervising  Engineer. 

The  nursing  in  Bellevue  is  conducted  and  supervised  by  the  Training 
School  for  Nurses,  an  independent  organization  with  which  the  Trustees 
of  Bellevue  Hospital  contract  for  the  services  rendered.  It  is  not  respon- 
sible to  the  Superintendent  of  the  Hospital,  and  makes  no  reports  to  him, 
and  the  only  method  of  coordinating  the  work  of  the  Superintendent  and 
that  of  the  Training  School  for  Nurses  is  periodic  conferences. 

The  social  service  work  of  the  Hospital  is  conducted  by  a  voluntary 
committee,  in  whose  service  there  are  officers  who  are  paid  by  the  Hos- 
pital. These  officers,  or  the  Committee,  make  no  periodic  reports  to  the 
Superintendent  about  the  work  performed,  and  are  practically  as  inde- 
pendent of  his  supervision  as  is  the  Training  School  for  Nurses.     The 


HOSPITAL   CONTROL  FORMS  687 

Social  Service  Department  is  supposed  to  be  a  department  of  the  Training 
School  for  Nurses  and  under  its  supervision. 

Inasmuch  as  a  new  system  of  medical  service  for  Bellevue  has  been 
recommended  by  the  Committee,  and  will  probably  be  installed,  it  seemed 
inadvisable  to  suggest  records  dealing  with  the  medical  service,  since  a 
changed  form  of  service  may  require  forms  and  reports  which  cannot 
readily  be  foreseen  at  the  present  time. 

The  Committee  has  confined  its  attention  to  forms  intended  to  regulate 
the  operation  of  the  physical  plant  and  the  use  of  materials  and  supplies. 
Also,  certain  forms  are  submitted  designed  to  give  the  Superintendent  of 
the  Hospital  some  supervision  over  the  work  of  the  Training  School  for 
Nurses  and  the  Social  Service  Department. 

The  forms  submitted  are  not  intended  to  be  a  complete  set  of 
forms  needed  for  the  operation  of  the  Hospital.  They  are  only 
meant  to  provide  more  adequate  forms  than  those  in  use  and  to  supply 
forms  for  reports  which  are  not  now  made.  No  attempt  has  been  made 
to  revise  forms  that  are  satisfactory,  nor  are  they  included  among  the  forms 
presented. 

In  drafting  the  forms  on  which  statistical  reports  are  to  be  made  the 
statistical  data  of  the  annual  report  has  been  kept  in  mind,  and  the 
periodic  reports  from  the  departments  made  to  conform,  so  far  as  possible, 
to  the  needs  of  the  annual  report. 

Additional  accounting  is  needed  in  connection  with  the  consumption  of 
various  supplies ;  such  as  cleaning  supplies,  laundry  materials,  etc.  The 
Comptroller's  Department  has  provided  a  system  of  accounting  for  most  of 
the  supplies  used  in  the  hospitals,  and  in  such  accounting  there  will  be  set 
forth  the  amount  of  the  items  mentioned  above.  It  seems  to  the  Committee 
that  it  would  be  highly  advisable  if  the  Hospital  would  select  from  such 
accounting  particular  articles  or  classes  of  articles  about  which  to  require 
separate  reports,  inasmuch  as  it  is  very  difficult  for  a  busy  supervising 
officer  to  examine  in  detail  a  report  covering  many  pages  and  several  hun- 
dred articles— the  important  articles  would  be  overlooked  in  the  mass  of 
details. 

Suggested  Forms 

Accounting  for  Food  and  Materials 

Report  on  Regular  and  Special  Diets 

The  record  of  the  regular  and  special  diets  is  kept  at  present  by  the 
Dietitian,  but  no  report  is  sent  to  the  Superintendent  of  the  Hospital. 
The  form  on  page  688  is  designed  as  the  basis  for  such  report. 

[Forms  dealing  with  the  distribution  of,  and  accounting  for,  food  are 
included  in  Part  i  of  this  Section  of  the  Report.] 


Condemned  Articles 

At  the  present  time  there  is  no  report  made  b)'  condemning  officers 
of  the  number  of  articles  condemned.  The  system  is  to  bring  back  a  worn- 
out  article  and  exchange  it  for  a  new  one  of  like  character  without  a  record 
being  made  of  the  fact  that  an  article  has  been  condemned,  and  no  record 
exists  in  the  Hospital  of  the  total  number  of  the  various  classes  of  articles 


688 


HOSPITAL   COMMITTEE 


Form  No.  1 

BELLEVUE   AND   ALLIED   HOSPITALS 

Bellevue  Hospital 
Report  of  Regular  and  Special  Diets  Prepared  in  Dietary  Department 

Month  ended 19 

[S^xlVA  inches] 


Uniform  Diets 

special  Sick  Diets 

Regular 

Day 

is 

iz 

6 

c 
_o 

s 

c 
o 

s 

c 
o 

TO    ^ 

(3 

c 
o 

Q 

Total 

1 

2 

3 

4 

5 

6 

7 

8 

9 
10 
11 
12 
13 
14 
15 
16 
17 
18 
19 
20 
21 
22 
23 
24 
25 
26 
27 
28 
29 
30 
31 

Total. 

• 

Report  to  be  made  monthly  to  the  General  Medical  Superintendent. 


HOSPITAL  CONTROL  FORMS  689 

thus  condemned.  The  following  forms  were  designed  to  provide  a  record 
of  all  condemnations,  so  that  the  Superintendent  may  readily  note  the 
rapidity  with  which  the  various  articles  are  being  worn  out  or  destroyed, 
and  by  comparison  of  the  list  of  condemned  articles  with  new  issues  an 
estimate  can  be  made  by  the  Superintendent  of  the  number  of  missing 
articles. 

Form  No.  2  is  to  be  made  out  by  heads  of  various  divisions  and  pre- 
sented with  the  articles  to  be  condemned  to  the  condemnation  officer 
in  charge  of  the  class  of  articles  to  be  condemned,  and  after  the  list  of  arti- 
cles has  been  condemned  and  the  Superintendent  has  affixed  his  signature 
approving  it  the  list  may  be  used  as  a  requisition  for  a  like  number  of 
similar  articles.  A  duplicate  copy  of  such  list  is  to  be  kept  by  the  con- 
demning officer  as  a  basis  of  monthly  report  to  the  Superintendent. 


Form  No.  3  provides  for  a  monthly  report  by  the  condemnation  officer. 

Form  No.  2 

BELLEVUE  AND   ALLIED   HOSPITALS 
Bellevub  Hospital 


Condemned  Articles 

The  following  articles  have  been  inspected  by  me  and  condemned, 
list  will  be  accepted  as  a  requisition  for  the  issue  of  articles  to 
take  the  place  of  the  articles  condemned. 
[SJ^x  8}^  inches] 


This 


Signed . 


Last  line  used.  No. 


Approved: Superintendent 


690 

Form  No.  3 


HOSPITAL  COMMITTEE 

BELLEVUE  AND   ALLIED   HOSPITALS 

Bellevue  Hospital 

Condemned  Articles 

Month  ended 


.19... 


List  such 
articles 
as  are 
likely  to  be 
used 

carelessly 
or  issued 
too  freely, 


Ward. 


opi 


Ward. 


Ward. 


Additional  col- 
umns provide  for 
all  wards,  dietary, 
laundry,  and 
other  general  de- 
partments. 


Total 


This  form,  17  x  17  inches,  provides  space  for  16  columns  for  wards  and  departments, 
and  2J4,  inches  for  margin  for  binding  space,  and  is  the  second  page  of  the  leaf;  second 
and  third  pages  provide  32  columns,  and  are  15J^  x  17  inches;  the  fourth  page  provides  18 
columns,  and  is  the  same  size  as  the  first  page. 

Accounting  for  Expensive  Drugs 

Although  the  forms  of  accounts  provided  by  the  Comptroller  provide 
for  the  accounting  of  the  distribution  of  drugs,  such  account  is  not  kept 
according  to  the  Divisions  of  the  Hospitals  and  according  to  the  Medical 
and  Surgical  Services.  It  seems  advisable  to  suggest  a  separate  report  upon 
the  more  expensive  drugs,  and  Form  No.  4  would  serve  this  purpose. 

Requisitioning  Food  Supplies 

The  form  of  requisition  for  food  supplies  at  present  used  in  Bellevue 
Hospital  is  inadequate  to  give  a  complete  check  upon  the  issue  and  the 
receipt  of  such  supplies.  It  records  the  amount  ordered  by  the  Dietitian 
and  the  amount  sent  from  the  storehouse  or  butcher  shop,  but  does  not 
provide  for  the  entering  of  the  amount  actually  received  in  the  various 
departments.  It  is  highly  important  that  the  amount  actually  received 
be  entered  by  the  person  responsible  for  receiving  the  goods,  and  that  the 
requisition  be  signed  by  such  agent  as  having  received  them,  with  the 
amount  indicated  opposite  each  article  thus  received.    If  there  is  any  dis- 


HOSPITAL   CONTROL  FORMS 


691 


O  -S 


panmsuoa  leioj, 


"    "<         t;: 


9j:^T33IHltldlxIY 


ooijgo  SmssgjQ 


I  'ip^a  JO  X:jt:;trent>  p  :^nin  uranpo  stqi  m  a^BOipu  ■ 


■a1 


'1^ 


^s 


692  HOSPITAL  COMMITTEE 

crepancy  between  the  amount  sent  from  the  storehouse  and  the  amount 
received  the  following  form  of  requisition  (No.  5)  will  make  clear  such 
discrepancy.  The  lines  are  numbered,  and  a  space  is  provided  for  the 
approving  officer  to  indicate  the  last  line  on  which  an  item  is  entered,  thus 
safeguarding  against  additional  entries  after  the  approving  officer  has 
affixed  his  signature. 


Form  No.  5 


No.  of  Officers 

No.  of  Staff  and  extra 

No.  of  Employees 

Paid 

Unpaid 

Total 

BELLEVUE  AND  ALLIED  HOSPITALS 
Bellevue  Hospital 

Requisition  for  Pood  Supplies 

Month  ended 19 . . 


The  following  supplies  are  requested  for. 


Signed 

[8J^  X  11  inches] 


Line 


Quantity- 
Needed 


Quantity 
Issued 


Quantity 
Received 


V 


Articles 


Remarks 


10 
11 
12 
13 
14 
15 
&c. 


To  be  made  out  in  triplicate. 


The  above  articles  were  received  in 

this  department 19 . . . 

and  were  weighed,  counted,  or  meas- 
ured. 

Signed 

White  form  for  personnel. 

CJolored  form  for  patients  or  inmates. 


Approved  for  issue 
By 


Last  line  used  No 

(\/)  Check  column  to  be  used  by  the  Dietitian. 


HOSPITAL   CONTROL  FORMS 


693 


The  foUowing  is  to  be  added  to  the  above  form  when  used  in  makingirequisitions 
for  supplies  for  patients  or  inmates: 


Number  of  patients  receiving  House  Diet 
Number  of  patients  receiving  Half  Diet 
Number  of  patients  receiving  Special  Diet 
Number  of  patients  receiving  Extra  Diet 
Number  of  patients  receiving  Tbc.  Diet 
Number  of  patients  receiving  Milk  Diet 
Number  of  patients  receiving  Children's  Diet 

Total 

Reports  by  Departmental  Heads  of  Work  Accomplished 

Report  of  Supervising  Engineer 

At  the  present  time  no  periodic  report  is  made  by  the  Supervising 
Engineer  to  the  Superintendent  of  the  institution.  It  seems  highly  advisable 
that  reports  should  be  made  shovifing  the  amount  of  coal  consumed,  water 
evaporated,  refrigeration  furnished,  and  ice  produced  and  issued.  Forms 
Nos.  6  and  7  were  designed  to  be  filled  out  by  the  Supervising  Engineer  and 
transmitted  to  the  Superintendent. 


Form  No.  6 

BELLEVUE   AND   ALLIED   HOSPITALS 

Bellevue  Hospital 

Coal  Report  for  24  Hours  Ended  12  o'clock  Midnight 19. . 

coal  consumed  and  water  evaporated 
[8}^x  5J^  inches] 


1st  Watch 

2d  Watch 

3d  Watch 

Total 

Pounds 
Coal 

Water 
Evapor- 
ated 

Pounds 
Coal 

Water 
Evapor- 
ated 

Pounds 
Coal 

Water 
Evapor- 
ated 

Pounds 
Coal 

Water 
Evapor- 
ated 

Boiler  No.  1 

Boiler  No.  2 

Boiler  No.  3 

Etc. 

This  report  to  be  made  out  daily  and  to  be  the  basis  of  a  monthly  report  to  the  General 
Medical  Superintendent. 


694 


HOSPITAL  COMMITTEE 


BELLE VUE   AND   ALLIED   HOSPITALS 
LPorm  No.  6J  Bellevue  Hospital 

Report  of  Engineering  Department  for  Month  Ended 


[_  Part  of   "| 


This  Month 

Last  Month 

This  Month 
Last  Year 

Remarks 

Pounds  coal  used 
Pounds  water  evaporated 
Average  temperature  for  month 
(Extend  to  include  tubes  and 
boilers  cleaned) 

■ 

Report  of  Employment  Agent 

The  Employment  Agent  at  the  present  time  renders  a  monthly  report 
to  the  Superintendent.  Such  report,  however,  does  not  indicate  the  actual 
number  in  service.  Form  No.  8  provides  a  column  for  this  information. 
Otherwise  the  form  is  similar  to  that  now  in  use. 

Report  of  the  Dental  Clinic 

The  Dental  Clinic  at  the  present  time  sends  a  daily  report  to  the 
Superintendent  of  the  Hospital  but  does  not  summarize  this  information 
and  present  it  in  the  form  of  a  monthly  report.  Form  No.  9  is  designed 
for  such  a  monthly  report. 

Report  of  Bureau  of  Investigation 

The  Bureau  of  Investigation  at  the  present  time  renders  no  report  of 
its  operations.  It  is  highly  important  that  the  Superintendent  should  know 
the  work  that  is  being  undertaken  and  what  has  been  accomplished.  Form 
No.  10  was  designed  as  a  monthly  report  of  the  Chief  Investigator  and  a 
form  somewhat  similar  might  be  used  as  an  annual  report. 


Report  of  Social  Service  Bureau 

The  Social  Service  Bureau  at  present  furnishes  no  formal  report  to  the 
Superintendent  of  the  Hospital.  The  work  done  by  this  Bureau  is  set  forth 
in  an  annual  report  pubhshed  by  the  Bureau,  but  no  periodic  report  is  sub- 
mitted to  the  Superintendent  which  will  inform  him  of  the  daily  operations 
of  that  department.  Form  No.  11  is  designed  to  accomplish  this  purpose, 
and  includes  only  such  information  as  is  at  the  present  time  compiled  for 
the  annual  report. 


HOSPITAL  CONTROL  FORMS 


695 


Form  No.  7 

BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 

Daily  Report  of  Cold  Store 

To  be  sent  daily  to  Supervising  Engineer. 

Date 

[8}i  X  11  inches] 


.19. 


Rooms 

Temperature 

A 

B 

C 

D 

E 

Tank 

Outside 

Remarks 

6  A.  M. 

12  m. 

6  P.  M. 

Ice  Issued 


Cold  Store 
OflSces 

Nurses'  Home 
Milk  Hall 

School  for  Attendants 


PavilionA&B 
&c. 


Total  Issued 
On  Hand 
Total 


Refrigerating  Plant 


Pressure 

Temperature 

g 

» 

0 

0 

S 

,s? 

Time 

i 

0 

1 

1 

II 

g 
0 

1 

< 

1 

.3 
Q 

i 

1 

S 

1 

B 
S 

1 
1 

S 

1 

II 
1" 

1' 

Pump 
Strokes 

Minute 

0 

a 

^ 

m 

U 

8 

12 

4 

8 

12 

4 

Signature. 


696 

Form  No.  8 


HOSPITAL   COMMITTEE 


BELLEVUE  AND  ALLIED  HOSPITALS 
Bellevue  Hospital 


Report  of  Employment  Agent,  Month  Ended 19 . 

[8J^  X  11  inches] 


This  Month 

This  Month  Last  Year 

l|l 

-3 

^5 

■gs 
^0 

fl 

ll 

ii 
^0 

Total 

Men 
Women 

Classified 

Desirable 
Undesirable 

Cause  of  leaving:  Absent 
Resigned 
Dismissed 

Departments: 

Housekeeping 

Laundry 

Main  Building 

Pavilion  A  &  B 

Dietary 

Yard 

Engineer 

Attendants 

Stables 

Storehouse 

School  for  Attendants 

Miscellaneous 

Length  of  Service 

2l 
SI 

"S 

Departments : 

Housekeeping 

Laundry 

Main  Building 

Pavilion  A  &  B 

Dietary 

Yard 

Engineer 

Attendants 

Stables 

Storehouse 

School  for  Attendants 

Miscellaneous 

HOSPITAL  CONTROL  FORMS 


697 


Form  No.  9 


BELLEVUE  AND  ALLIED  HOSPITALS 

Bellbvue  Hospital 
Report  of  Work  Done  in  Dental  Clinic 

Month  ended 

15}4  X  8H  inches] 


.19.... 


Dentists  in  attendance 

Visits  of  dentists  during  month 

Total  hours  service  by  visiting  dentists. 

Number  of  Patients — Adults 

Children 

Visits  by  parents 


Teeth  cleaned 

Teeth  extracted 

Teeth  filled,  Amalgam 

Teeth  fiUed,  Cement 

Teeth  filled,  Gutta  Percha 

Teeth  fiUed,  Copper-amalgam 
Teeth  filled,  Copper-cement  .  . 

Treatments 

Fractures 

Surgical  operations 

Total  operations . 


Report  to  be  compiled  monthly  by  the  nurse,  from  her  daily  record. 

Signed 


Nurse 


Report  of  the  Pathological  Department 

The  Pathological  Department  at  the  present  time  renders  two  reports 
to  the  Medical  Board  but  none  to  the  Superintendent  of  the  Hospital.  It 
seems  advisable  that  such  a  report  should  be  rendered,  and  the  information 
called  for  in  the  two  reports  has  been  combined  into  one  form.  No.  12,  to 
be  filled  out  and  submitted  monthly  to  the  Superintendent  of  the  Hospital. 

At  the  present  time  there  is  no  record  of  the  attendance  of  physicians 
at  autopsies.  The  Hospital  requires  physicians  to  record  the  time  of  ar- 
rival at,  and  departure  from,  the  Hospital.  It  would  seem  equally  advisable 
to  have  a  record  of  the  attendance  of  physicians  at  autopsies.  Forms  Nos. 
13  and  14  provide  for  this  information. 


Report  of  the  Rontgen-Ray  Department 

At  the  present  time  the  Rontgen-Ray  Department  makes  no  periodic 
report  to  the  Superintendent  of  the  Hospital.  Form  No.  15  is  designed  to 
be  used  for  this  purpose. 


698 

Form  No.  10 


HOSPITAL   COMMITTEE 

BELLEVUE  AND  ALLIED   HOSPITALS 

Bellevue  Hospital 

Monthly  Report  of  Bureau  of  Investigation 


Month  ended . 
3J4  XII  inches] 


.19. 


a.  Number  of  cases  pending  first  day  of  month . . . 

b.  Number  of  new  cases  taken  up 

c.  Total  number  of  cases  in  charge  during  month . 

d.  Number  of  interviews  in  Wards 

e.  Number  of  interviews  in  O.  P.  D 

f .  Number  of  interviews  in  Field 

g.  Number  of  cases  pending  last  day  of  month ... 


Classification  of  Cases 


Number  of  classified  cases  pending  at  1st  of  month . 
Number  of  cases  classified  during  month 


Aliens  and  Non-Residents 


S 

m 

.aV. 

0*0 

<'d 

j->  S-ti 

1 

8 
1 
1 

1 

g 
2; 

P  g 
0  g 

-gi 
Pi 

\iPi 

0 

Qi 

si 

3  . 

•d<l 

fcri 
'oJra 

15 

WP  a, 

Aliens 

Non-residents 

Total 

Number  of  aliens  having  history  of  morbidity  prior  to  landing  in  U.  S. 

Amount  collected  from  U.  S.  Government 

Amount  collected  from  New  York  State 

Amount  collected  from  private  sources  for  aliens 

Amount  collected  from  other  paying  patients 


Chief  Investigator . 


The  above  report  to  be  made  out  monthly  by  the  head  of  the  Bureau  and  sent  to 
the  General  Medical  Superintendent. 

The  same  data  to  be  assembled  by  the  head  of  the  Bureau  into  an  annual  report. 


HOSPITAL   CONTROL  FORMS 


699 


Form  No.  11 


BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 

Monthly  Report  of  the  Bureau  of  Social  Service 


Month  ended . 
[8K  X  11  inches] 


.19... 


Cases  actively  in  charge  first  of  month 

New  cases  t^en  up 

Old  cases  continued  or  reopened 

Patients  requiring  slight  service,  telephone  messages,  etc. 

Patients  requiring  intensive  social  service 

Cases  remaining  actively  in  charge  at  end  of  month 


Classification  of  Cases 


0 

So 

11 

■3 

3 
^ 

1 

1 

0.. 

3 

Cases  treated  by  the  Bureau 

Visits  to  home  by  social  service 
worker 

Miscellaneous  calls  by  social  ser- 
vice worker 

Hospital  cases  referred  to  other 
agencies 

Dispensary    patients    referred    to 
other  agencies 

OfiBce  interviews  by  social  service 
workers 

Total 

Number  of  Committee  meetings  h( 
Aggregate  attendance  at  all  Comrn 

;ld 

littee 

meet 

ings 

Statistical  Reports 


Census  Report  for  Wards 


At  the  present  time  the  report  from  the  wards  gives  merely  the  num- 
ber of  admissions  and  discharges.  It  seems  highly  advisable  to  have  a 
report  from  the  v^^ards  daily  that  will  indicate  the  names  of  the  patients 
received  by,  and  also  those  discharged  from,  such  wards.  This  informa- 
tion is  necessary  to  check  the  records  in  the  admitting  office  showing  the 


700 


HOSPITAL   COMMITTEE 


W    « 


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First  Surgical 
Children 
Second  Medical 
Second  Surgical 
Second  Gynecological 
Third  Medical 
Third  Surgical 
Third  Gynecological 
Fourth  Medical 
Fourth  Surgical 
Fourth  Gynecological 
Psychopathic 
Alcoholic 
Prison 

Tuberculosis 
Obstetrical 
School  of  Midwifery 
Erysipelas 
Reception  Office 

HOSPITAL  CONTROL  FORMS 


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assignment  and  discharge  of  patients.     Form  No.  16  provides  for  the  re- 
cording of  such  information. 

Form  No.  17  provides  for  the  compilation  of  the  information  on  Form 
No.  16  as  applied  to  the  vi^hole  institution. 


Form  No.  15 


BELLEVUE  AND   ALLIED   HOSPITALS 

Bellevue  Hospital 

Report  of  R6ntgen-Ray  Department 

Month  ended 

[8J^  X  11  inches] 


.19. 


Services 


Name  of  Physician 
or  Surgeon 


Patients 


Plates 


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Second  Surgical 
Third  Surgical 
Fourth  Surgical 
First  Medical 
Second  Medical 
Third  Medical 
Fourth  Medical 
Out-Patient  Department 
Tuberculosis 
Maternity 
Children's 

Total 


Conditions  Examined 


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Medical  Superintendent. 


704 


HOSPITAL   COMMITTEE 


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HOSPITAL   COMMITTEE 


Report  of  Assignment  of  Nurses 

At  the  present  time  no  report  is  made  by  the  Superintendent  of  the 
Training  School  for  Nurses  as  to  the  assignment  of  nurses  and  the  num- 
ber on  duty  in  the  various  departments  daily.  It  seems  highly  desirable 
that  the  Superintendent  should  have  in  hand  such  a  record.  At  the 
present  time  it  is  not  deemed  advisable  to  have  such  a  report  made  daily 
to  the  Superintendent  of  the  Hospital.  Form  No.  i8  (opposite)  provides  for 
a  monthly  report  which  will  be  based  upon  similar  information  recorded 
daily  in  the  office  of  the  Superintendent  of  the  Training  School. 

Report  of  the  School  for  Midwives 

At  the  present  time  the  School  for  Midwives  makes  no  periodic  report' 
to  the  Superintendent  of  the  Hospital  except  the  information  compiled  for 
the  annual  report.  It  seems  advisable  that  the  Superintendent  should  be 
informed  at  shorter  intervals  of  the  operation  of  the  School.  Form  No.  19 
is  provided  for  this  purpose. 

Form  No.  19 

BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 

School  for  Midwives 


Month  ended . . . 
[5K  X  8M  inches] 

....19.... 

Males 

Females 

Total 

Patients  remaining  first  of  month 
Babies  remaining  first  of  month 
Patients  admitted  during  month 
Babies  admitted  during  month 
Births 
Stillbirths 

Total  during  month 

Deaths  of  mothers 

Deaths  of  babies 

Stillbirths 

Mothers  discharged 

Babies  discharged 

Patients  remaining  end  of  month 

Babies  remaining  end  of  month 

Total  during  month 

Record  of  Attendance 

Record  of  Attendance  of  Internes 
At  the  present  time  there  is  no  check  upon  the  time  rendered  by  in- 
ternes or  the  regularity  of  their  work  in  the  wards.  It  seems  advisable  that 
the  attending  staff,  and  also  the  Superintendent  of  the  Hospital,  should 
be  fully  informed  as  to  the  service  rendered  by  the  internes.  Form  No.  20 
is  designed  to  accomplish  this  purpose.  It  should  be  a  loose-leaf,  with 
perforations,  made  in  tablet  form;  a  sheet  to  be  filled  out  each  day  and 
signed  by  the  Resident,  and  subsequently  transmitted  to  the  Chief  of  the 
service  and  then  to  the  Superintendent  of  the  Hospital. 


BELLEVUE   AND   ALLIED   HOSPITALS 

Bellevue  Hospital 

Monthly  Report  of  Assignment  of  Nurses 


Month  ended 19 . 


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Bed  capacity 
Average  daily  census 
Total  admissions  for  month 
Assignment  (average  for 

month) 
Supervising  Nurses 

Superintendent  Training  School 

Instruction 

Nurses'  Home 

Operating  room 

Total 

Head  Nurses 
Wards,  day 
Wards,  night 
Relief 

Operating  room 
Clerical 

Otherwise  assigned 
Average  number  sick 
Average  number  absent 

Total  Trained  Nurses 

Pupil  Nurses 
Wards,  day 
Wards,  night 
Otherwise  assigned 
Average  number  sick 
Average  number  absent 

Total  Pupil  Nurses 

Total  Nurses 

HOSPITAL   CONTROL  FORMS 


707 


Form  No.  20 


BELLEVUE  AND   ALLIED   HOSPITALS 

Bellevue  Hospital 

Staff  Register 


To  be  used  by  the  residents  and  internes  in  each  service. 
Record  times  of  going  on  and  off  duty  each  day. 


Date. 
[8}4  X  11  inches] 


PLEASE  USE  SPACE  IN  ORDER  OF  COMING  ON  DUTY 


Names 


A.  M. 


On  Duty  Off  Duty 


P.M. 


On  Duty  OS  Duty 


Emergency 
CaUs 


This    certifies   that    I   have 
examined  the  above  register. 


.  Resident 


Comments. 


Record  of  Leaves  of  Absence 

A  form  is  now  in  use  in  Bellevue  Hospital  providing  for  leaves  of  ab- 
sence of  internes.  On  the  reorganization  of  the  medical  service  such  form 
would  necessarily  need  to  be  changed.  Form  No.  21  provides  for  such 
change.  A  modification,  for  the  like  purpose,  is  submitted  in  Form  No.  22, 
for  use  in  the  Out-Patient  Department,  to  be  used  in  connection  with  ab- 
sences of  the  attending  staff  of  the  Out-Patient  Department. 


708  HOSPITAL  COMMITTEE 

Form  No.  21 

BELLEVUE  AND   ALLIED   HOSPITALS 
Bellevue  Hospital 

Date 19 

To  the  President,  Board  of  Trustees, 

Bellevue  and  Allied  Hospitals. 
Dear  Sir: 

I   respectfully   apply   for   a   leave   of   absence   of days   from   my 

duties  as on  the  staEE  of  Bellevub 

Hospital,  beginning  on  the of 19 

I  recommend  as  substitute,  subject  to  your  approval,  Dr 

Very  respectfully, 


Approved Chief  of  Division 

Approved General  Medical  Supt. 

Data  in  regard  to  substitute 

Dr is  a  graduate  of 

Experience 


Reference. 


[8J^  X  11  inches] 


Form  No.  22 

BELLEVUE   AND   ALLIED   HOSPITALS 
Bellevue  Hospital 

Date 19 

To  the  Board  of  Trustees, 

Bellevue  and  Allied  Hospitals. 
Gentlemen: 

I  respectfully  apply  for  a  leave  of  absence  from  my  duties  as 

in  the clinic  of  the 

Out-Patient  Department  of  Bellevue  Hospital,  to  begin  on  the day  of 

19 .... ,  and  to  end  on  the day  of 

19.... 

During  my  absence  my  service  will  be  attended  to  by  Dr 

Respectfully, 

M.  D. 

Approved Chief  of  Service 

Approved Chief  of  Clinic 

Approved General  Medical  Superintendent 

Notice  sent 19 ... . 

Secretary 

[8J^  X  11  inches] 


HOSPITAL  CONTROL  FORMS  709 

Patients'  Clothing 

The  record  forms  now  in  use  in  Bellevue  Hospital  in  connection  with 
the  care  of  the  clothing  of  patients  do  not  clearly  establish  the  ownership 
of  the  various  articles  of  clothing.  The  records  have  been  faulty  in  con- 
nection with  the  accounting  for  clothing,  both  as  to  the  delivery  of  such 
clothing  to  friends  or  to  patients,  and  as  to  the  condemnation  of  clothing 
when  uncalled  for.  At  present  the  man  in  charge  of  the  clothing  does 
not  get  a  full  receipt  for  the  delivery,  and  so,  while  all  the  clothing  has  been 
delivered,  the  receipt  does  not  clearly  estabHsh  that  fact.  Forms  Nos.  23,  24, 
25,  and  26  were  designed  to  overcome  these  difficulties. 


Laundry  Accounting 

At  the  present  time  no  accurate  account  is  rendered  by  the  laundry 
of  the  work  done  in  the  laundry  day  by  day.  Upon  request  of  the  Super- 
intendent an  estimate  is  made  of  the  amount  of  work  done  in  the  laundry 
during  a  given  period.  This  estimate  is  made  by  counting  the  amount  done 
on  a  particular  day  and  multiplying  it  by  the  days  in  the  period  for  which 
a  report  is  to  be  made.  It  seems  highly  advisable  that  an  accurate  account 
should  be  made  by  the  laundry  of  all  work  done  day  by  day,  as  otherwise 
it  would  be  impossible  to  determine  who  might  be  responsible  for  shortages. 

At  the  present  time  no  accounting  of  articles  sent  out  of  the  wards  to  the 
laundry  is  made,  which  in  case  of  the  loss  of  any  such  articles  makes  it 
impossible  to  place  responsibility  for  such  loss.  Forms  Nos.  27,  28,  and 
29  were  designed  to  account  for  the  laundry  work  from  the  time  of  leaving 
the  ward  until  the  time  it  is  returned  to  the  ward.  The  method  of  using 
these  forms  would  be  as  follows: 

Form  No.  27,  printed  upon  durable  paper,  would  be  made  out  by  the 
nurse  for  the  ward.  The  account  registered  in  the  first  column  would  be 
checked  by  the  person  in  charge  of  the  central  linen  room  and  the  items 
then  listed  in  the  second  column.  The  issue  for  the  ward  would  be  listed  in 
the  third  column,  and  the  totals  for  each  carried  forward  into  the  last 
three  columns.  This  form  would  remain  in  the  laundry  and  become  the 
basis  for  the  monthly  report  provided  in  Form  No.  29. 

Form  No.  28,  private  laundry  list,  would  be  used  in  the  same  manner. 


Reports  on  Long  Term  Patients 

'  From  time  to  time  cases  are  retained  in  the  psychopathic  wards  longer 
than  the  law  provides  for  and  no  report  of  such  cases  is  now  made  to  the 
Superintendent  of  the  Hospital.  Form  No.  30  provides  a  report  which 
will  make  these  cases  a  matter  of  record. 

At  present  only  cases  that  have  been  in  the  Hospital  three  months 
are  reported  to  the  Superintendent  of  the  Hospital  as  long  term  medical 
or  surgical  cases,  and  no  report  of  patients  having  been  readmitted  several 
times  for  the  same  ailment  is  made.  Form  No.  31  is  designed  to  take  care 
of  these  cases. 


7IO 


HOSPITAL  COMMITTEE 


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HOSPITAL  CONTROL  FORMS 


711 


Form  No.  25 


/ 

Ward 

0 

\ 

Name  of  Patient 

Clothes  Room  No. . 
Date 

10 

Articles  not  in  bag 

Nurse 

Patient's  Receipt. 

Received  from  Bellevue  Hospital  all  articles  of  clothing 
deposited  at  time  of  admission. 

Patient 

[3M  X  Wi  inches] 


712 

Form  No.  26 


HOSPITAL   COMMITTEE 


BELLEVUE  AND   ALLIED   HOSPITALS 
Bellevue  Hospital 


List  of  Unclaimed  Clothing  Sent  from  Patients'  Clothes  Room  to  Housekeeper 
FOR  Disposal 


Date. 
y/2  X  11  inches] 


Clothes  Room 
Number 


V 


Name  of  Patient 


Condemned 
(To  be  checked 

by  the 

condemnation 

officer) 


Sent  to 

Social  Service 

Bureau 


Remarks 


In  charge  Clothes  Room 


Condemnation  Officer 


This  list  to  be  made  out  weekly  and,  after  being  checked  by  the  condemnation  officer, 
to  be  filed  in  a  binder  in  the  Clothes  Room. 

Notification  Slips  Pertaining  to  Patients 

The  control  of  discharges  and  transfers  is  not  at  present  vested  in  the 
Chief  of  a  service.  In  the  form  now  used  it  is  provided  that  the  house 
officer  may  sign  the  order  for  discharge  or  transfer.  Form  No.  32  pro- 
vides for  the  signature  of  the  Chief  and  approval  of  the  Superintendent. 

At  the  present  time  there  is  no  provision  for  any  clinical  data  to  be 
sent  from  one  hospital  to  another,  and  Form  No.  33  has  been  devised  for 
the  benefit  of  the  hospital  to  which  a  patient  has  been  transferred. 

At  the  present  time  when  a  patient  is  discharged  and  referred  to  the 
Out-Patient  Department  there  is  no  form  used  to  give  the  Out-Patient 
Department  sufficient  data  for  the  continuance  of  the  treatment.  Form 
No.  34  is  to  be  filled  out  by  the  Resident  and  sent  to  the  Out-Patient  Depart- 
ment. Form  No.  35,  which  contains  no  medical  data,  is  to  be  given  to  the 
patient  and  taken  by  him  to  the  Out-Patient  Department. 

It  seems  wise  that  the  Superintendent  should  be  given  information  as  to 
the  cases  showing  sepsis,  either  before  or  after  operation,  and  for  this  pur- 
pose Form  No.  36  is  to  be  made  out  by  the  Resident  and  sent  to  the  Super- 
intendent each  month. 

In  all  hospitals  rules  are  established  with  regard  to  the  giving  of  baths 
and  care  of  hair  of  patients  in  the  wards,  and  yet,  in  a  great  many  cases, 


HOSPITAL  CONTROL  FORMS  713 

complaints  arise  in  regard  to  the  condition  of  patients  in  this  respect. 
Form  No.  37  gives  the  Superintendent  a  record  of  what  is  done  in  the 
wards,  so  that  it  may  be  referred  to  in  adjusting  complaints. 

It  is  the  present  practice  for  the  nurse  to  notify  the  Superintendent 
by  telephone  in  regard  to  cases  of  dangerous  illness  or  deaths.  Forms  Nos. 
38  and  39  make  these  matters  of  record,  and  should  be  sent  to  the  desk  of 
the  Superintendent  as  confirming  the  telephone  messages. 


714 


HOSPITAL  COMMITTEE 


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HOSPITAL  CONTROL  FORMS  715 

Form  No.  28 

BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 

Private  Laundry  List 

Name 

Mark 

Room  No 

[5J^  X  8J^  inches] 


Sent 


Received  at 
Laundry 


Returned 


Trousers 

Coats 

Shirts 

Soft  shirts 

Undershirts 

Drawers 

Union  suits 

Nightshirts 

Pajamas 

Collars 

Cuffs 

Ties 

Handkerchiefs 

Hose 

Vests 

Washcloths 


Total  pieces 


Form  No.  29 


BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 

Monthly  Report  of  Work  Done  in  Laundry 

Month  ended 

WA  X  8}^  inches] 


.19.. 


1                             

Starched 

Flat  Work 

Ironed 

and 
Ironed 

Total 

Wards 

&c. 

This  report  to  be  compiled  from  the  weekly  laundry  lists. 
Attach  to  this  the  monthly  report  of  supplies  and  equipment. 


7i6 

Form  No.  30 


HOSPITAL  COMMITTEE 


BELLEVUE  AND   ALLIED   HOSPITALS 

Bellevue  Hospital 

Report  of  Psychopathic  Cases  Remaining  Longer  than  10  Days  in  Hospital 

Date 19.. 

[SJ^xll  inches] 


Names  of  Patients 

Diagnoses 

Condition 

Dates  of 
Admission 

Dates  of 
Discharge 

Reasons  for 
Retaining 

Comments 


.  Resident 


Form  No.  31 

BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 

Service Ward 

Report  of  Patients  Having  Had  90  Days  Treatment  Within  12  Months  Previous 

Date 19 

[8}^  X  11  inches] 


Names  of  Patients 


Diagnoses 


Condition 


Dates  of 
Admission 


Dates  of 
Discharge 


Reasons  for 
Returning 


Comments 


Signed Resident 


HOSPITAL  CONTROL  FORMS  717 

Form  No.  32 

BELLEVUE  AND  ALLIED  HOSPITALS 

.Bellevue  Hospital 

Date 19 

Registrar: 

You  will  kindly  notify  the  friends  of  the  following  patients  that  they  will  be  transferred 
to  one  of  the  hospitals  of  the  Department  of  Public  Charities,  as  they  are  in  a  physical 
condition  to  stand  transferring: 


Ward Name. 

Ward Name . 


Chief  Physician-Surgeon 
Approved Superintendent 

N.  B.:    These  slips  are  to  be  signed  by  the  Chief  of  the  Division  only. 
(Slips  similar  to  the  above  are  now  in  use.) 

[8H  X  11  inches] 

Form  No.  33 

BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 

Transfer  Slip  Date 19 

Name Sex Age M.  S.  W. 

T       .  T-.      ■  1  ....        /State  or\  /'Citizen\ 

Last  Residence Nativity  l^Country/ ^  Alien  ) 

(If  a  widow)  Was  husband  a  citizen? (If  unmarried  woman)  Was  father  a  citizen? .... 

Occupation Education Religion 

Name  of  father Birthplace 

Name  of  mother Birthplace 

Name  of  friend Address 

Name  of  friend Address 

Diagnosis Condition 

Medical  treatment 


In  cases  of  accident  give  time,  place,  and  circumstances  . 


.Resident 
....Chief 


This  history  slip  fully  filled  out  should  be  sent  with  the  patient  when  transferred. 
[53^  X  SYz  inches] 


7l8  HOSPITAL  COMMITTEE 


Form  No.  34 

BELLEVUE  AND  ALLIED   HOSPITALS 

_      Bellkvue  Hospital 


M Address 

was  treated  in  the  Dressing  Office  at p"  y^ 19 . 

and  referred  to  the  Out-Patient  Department. 

Injuries: 


Treatment  given: 


Approved Signed 

Superintendent  Resident 

(This  form  must  be  made  out  and  sent  to  the  Main  Office  for  approval.    It  will  be 
sent  to  the  Out-Patient  Department  and  filed  there  with  the  patient's  history.) 

WA  X  11  inches] 


Form  No.  35 

BELLEVUE   AND  ALLIED   HOSPITALS 

Bellevue  Hospital 
Dressing  Office 

M Address 

was  treated  in  the  Dressing  Office  at p  m' 

and  referred  to  the  Out-Patient  Department. 

READ  THIS:    Come  to  the  Out-Patient  Department  and  show  this  card  at 


o'clock ^;  ^; 19 ... . 

(This  form  to  be  torn  oflE  from  above  and  given  to  patient.) 


HOSPITAL  CONTROL  FORMS 


719 


Form  No.  36 

BELLEVUE  AND  ALLIED  HOSPITALS 
Bellevue  Hospital 
To  the  General  Medical  Superintendent: 

The  following  is  a  statement  of  the  cases  showing  sepsis,  either  before  or  after  opera- 
tion as  noted  below. 

Month  ended 19 

[S\i  X  11  inches] 


Ward 


Names  of  Patients 


Diagnoses 


Sepsis 

Before 

Operations 


Sepsis 

After 

Operations 


Remarks 


Number  of  operations Resident 

Form  No.  37 

BELLEVUE  AND  ALLIED  HOSPITALS 

Bellevue  Hospital 

Report  of  Baths  and  Care  of  Hair  of  Patients  in  Ward 

Week  ended 19 ... . 

[S}4  X  11  inches] 


Number 
of  Bed 


Date 


Number 
of  Bed 


Date 


Number 
of  Bed 


Date 


Patients  are  to  receive  a  bath  on  entrance  unless  exception  is  made  by  the  admitting 
physician. 

Patients  are  to  receive  a  cleansing  bath  once  a  week,  and,  in  addition,  as  often  as  occa- 
sion requires.     Feet  must  be  bathed  at  least  twice  a  week. 

Patients'  hair  must  receive  "attention"  on  entrance,  and  also  every  week  during  their 
stay  in  the  hospital,  and  oftener  if  occasion  requires. 

The  nurse  should  enter  upon  this  report  "T"  for  tub  bath;  "B"  for  bed  bath;  and 
"H"  for  attention  to  hair. 

Report  to  be  sent  to  the  General  Medical  Superintendent  at  end  of  week. 


720 


HOSPITAL  COMMITTEE 


FOBM  No.  38 


DANGEROUSLY  ILL 

Date 19.. 

To  the  Superintendent: 

Name 

Ward Bed. 


Service  of  Dr. 

Disease 

Remarks 


.Resident 


[3M  X  4:14  inches] 


HOSPITAL  CONTROL  FORMS 


721 


Form  No.  39 


DEATH  NOTICE 

Date 19 

To  the  Superintendent: 
I  beg  to  advise  that 

Name 

who  suffered  from 

in  Ward died  at 

o'clock  on  the day  of 

19. . . . 


.Resident 


N.  B.:  This  slip  must  be  delivered  to  the  office  of  the 
Superintendent  upon  verification  of  the  death  of  every 
patient. 


[3M  X  i}4  inches] 


Section  X.— SOME  PROBLEMS  AND  REORGANIZATIONS 

1.  Proposed    Reorganization    of    the    Medical    Service    in 

Bellevue  Hospital 

2.  Some  Problems  Common  to  all  the  Departments 


I.  PROPOSED  REORGANIZATION  OF  THE  MEDICAL 
SERVICE  IN  BELLEVUE  HOSPITAL 


FOREWORD 

Bellevue  Hospital  has  been  justly  renowned  throughout  the  country  as 
one  of  the  leading  general  hospitals,  and  it  has  stood  for  work  of  high  char- 
acter. The  investigation,  however,  has  shown  some  weaknesses  and  short- 
comings which  seem  to  call  for  correction.  The  difficulties  noted  have  been 
due  primarily  to  too  brief  a  time  spent  in  the  hospital  by  attending  physi- 
cians or  too  frequent  rotation  of  the  personnel  of  the  attending  staff.  The 
following  memorandum  sets  forth  this  condition  and  recommends  a  plan 
of  reorganization  designed  to  overcome  the  difficulties  and  shortcomings 
noted. 


MEDICAL  AND  SURGICAL  SERVICES  IN  BELLEVUE  HOSPITAL 

Organization 

So  far  as  the  care  of  patients  is  concerned,  Bellevue  Hospital  consists 
practically  of  four  hospitals.  With  the  exception  of  certain  specialized 
services,  the  Hospital  is  composed  of  four  divisions;  three  of  which  are 
assigned  to  the  following  medical  colleges :  the  First  Division  to  the  College 
of  Physicians  and  Surgeons,  a  department  of  Columbia  University;  the 
Second  Division  to  Cornell  Medical  School,  a  department  of  Cornell  Uni- 
versity ;  and  the  Third  Division  to  New  York  and  Bellevue  Medical  School, 
a  department  of  New  York  University.  The  Fourth  Division  is  known  as 
an  "Open  Division,"  wherein  physicians  and  surgeons  may  serve  who  are 
not  attached  to  the  faculty  of  any  medical  school.  Some  services  are  under 
the  direct  supervision  of  the  Hospital,  such  as  the  Psychopathic  and  Alco- 
holic Services,  the  School  for  Midwives,  the  Tuberculosis  Camp  Boat,  and 
the  Pathological  Department.  The  children's  Medical  Service  is  assigned 
to  the  First  Division,  and  the  Surgical  Service  for  children  is  divided  among 
the  four  Divisions.  All  except  the  First  Division  have  a  Gynecological 
Service.  The  four  Divisions  rotate  through  the  Erysipelas  and  Tuberculosis 
Services. 

Until  April  8,  1913,  the  control  of  the  Services  was  exercised  by  a 
Medical  Board  composed  of  about  40  members.  On  that  date  the  Board 
of  Trustees  passed  a  resolution  reconstructing  the  Executive  Committee  of 
the  Medical  Board,  and  gave  it  authority  to  have  "supervision  and  execu- 
tive control  over  the  medical  management  of  the  Hospital."  By  this  reso- 
lution the  Executive  Committee  supplanted  the  Medical  Board  in  so  far  as 
the  management  of  the  Medical  Service  is  concerned.  The  Committee 
consists  of  one  physician  and  one  surgeon  from  each  of  the  four  Divisions 
and,  ex  officio,  the  General  Medical  Superintendent  and  the  Director  of 
Laboratories. 

At  this  same  meeting  of  the  Trustees  a  resolution  was  adopted  appoint- 
ing the  President  of  the  Board  of  Trustees  and  the  President  of  the  Medical 
Board  as  a  committee  to  confer  with  Mr.  Henry  S.  Pritchett,  of  the  Carnegie 
Foundation,  "as  to  the  appointment  of  an  expert  to  advise  the  Board  of 
Trustees  in  regard  to  a  plan  or  policy  of  medical  and  teaching  reorganization 
of  the  new  Bellevue  Hospital." 

Your  Committee  had  drafted  a  plan  for  the  reorganization  of  the  Medi- 
cal Service  in  Bellevue,  in  March,  1913,  and  had  entered  into  conferences 
with  the  President  of  the  Bellevue  Board,  and  the  action  of  the  Board  of 
Trustees  of  the  Hospital  indicated  that  the  Board  recognized  the  advisa- 
bility or  necessity  of  some  kind  of  a  reorganization. 

The  Medical  Board  is  in  a  large  measure  self-perpetuating,  in  that 
each  Division  makes  nominations  to  fill  vacancies,  which  nominations  are 
submitted  to  and  passed  upon  by  the  Medical  Board  and  subsequently  con- 
firmed by  the  Trustees.  In  but  one  instance  in  recent  years  have  thev  re- 
fused to  accept  the  nomination  made  by  the  Medical  Board. 

729 


730 


HOSPITAL   COMMITTEE 


Visiting  Staff 

The  Visiting  Staff  of  each  Division  is  composed  of  Visiting,  Assistant 
Visiting,  and  Adjunct  Assistant  Visiting  Physicians  and  Surgeons,  all  serv- 
ing without  pay.  Each  Division  has  four  Visiting  Physicians,  who  rotate 
in  periods  of  three  months  each  during  the  year.  These  four  men,  repre- 
senting a  Division,  nominate  one  or  more  Assistant  Visiting,  and  Adjunct 
Assistant  Visiting  Physicians  or  Surgeons.  The  Assistant  Visiting,  and 
Adjunct  Assistant  Visiting  Physicians  and  Surgeons  not  only  assist  the 
Visiting  Physicians  and  Surgeons,  but  also  serve  in  their  absence.  The 
amount  of  time  to  be  given  by  the  Visiting  Staff  is  not  specified  by  any 
regulation,  but  is  supposed  to  be  sufficient  to  insure  proper  medical  and 
surgical  care.  When  none  of  the  members  of  the  Visiting  Staff  are  present 
in  the  Hospital  the  care  of  the  patients  devolves  upon  the  House  Staff. 

The  personnel  of  the  staff  of  Visiting  Physicians  rarely  changes;  the 
same  members,  with  few  exceptions,  have  served  the  Hospital  for  many 
years. 


House  Staff 

The  House  Staff  is  composed  of  graduate  medical  students.  Each  Divi- 
sion, except  the  Third,  holds  an  open  competitive  examination.  The  Third 
Division  limits  the  applicants  to  its  examination  to  graduates  of  the  New 
York  and  Bellevue  Medical  School.  These  examinations  in  former  years 
were  held  late  in  spring,  but,  owing  to  competition  between  hospitals,  they 
have  been  gradually  pushed  forward  until  at  the  present  time  they  are 
usually  held  in  February  or  March.  This  midwinter  examination  makes  it 
very  difficult  for  students  from  other  parts  of  the  country  to  be  present  in 
New  York  City  for  examination.  The  internes  thus  selected  through  ex- 
amination are,  both  in  theory  and  practice,  officers  of  the  Divisions,  rather 
than  of  the  Hospital  itself.  The  Hospital  has  practically  no  control  over 
the  interne  staff,  except  that  they  may  be  disciplined  or  discharged  for 
gross  misconduct.  Almost  the  entire  management  and  control  of  the  interne 
staff  rests  in  the  hands  of  the  Visiting  Staff. 

The  function  of  the  House  Staff  is  to  care  for  the  patients  under  the 
direction  of  the  Visiting  Staff,  and  to  have  full  charge  in  the  absence  of 
members  of  the  Visiting  Staff.  Inasmuch  as  members  of  the  Visiting  Staff 
are  present  in  the  Hospital  but  a  small  portion  of  the  24  hours  of  the 
day,  the  major  number  of  patients  are  admitted  in  their  absence.  These 
patients  must  be  examined  by  the  House  Physician  or  Surgeon,  and  they 
are  supposed  to  be  subsequently  examined  by  the  Visiting  Staff.  The  House 
Staff  is  responsible  for  keeping  the  medical  records. 

The  House  Physician  or  Surgeon  is  a  senior  interne,  and  serves  in  such 
position  for  6  months  after  having  served  in  the  Hospital  for  a  period  of 
18  months.  The  internes,  at  the  time  of  examination,  according  to  standing, 
are  allowed  to  choose  whether  they  shall  serve  for  one  year,  18  months,  or 
two  years,  and  it  is  understood  that  those  who  choose  to  serve  two  years 
will  become  House  Physicians  or  Surgeons. 

A  junior  interne  is  assigned  to  each  ward,  under  the  supervision  of  the 
Senior  Resident,  who  exercises  control  over  him  and  assigns  certain  duties 
to  him.  He  takes  clinical  histories ;  performs  the  clinical  laboratory  work ; 
looks  after  pus  dressings  in  the  Surgical  Service ;  acts  for  his  senior  in  his 
absence ;  and  performs  such  other  duties  as  may  be  assigned  to  him. 


REORGANIZATION   OF  MEDICAL   SERVICE  731 

Admission  of  Patients 

There  are  three  Admitting  Physicians  paid  by  the  City  ($1,000  per 
annum).  Two  of  these  are  on  duty  during  the  day,  relieving  each  other  at 
stated  hours,  and  one  is  on  duty  all  night.  The  tenure  of  office  is  indefinite. 
They  are  appointed  by  the  Trustees  and  are  selected  from  among  house 
officers  who  have  completed  their  term  of  service.  They  are  at  times 
assisted  in  their  duties  by  members  of  the  House  Staff.  The  Admitting 
Physicians  are  on  the  staff  of  the  Superintendent  and  at  times  are  called 
upon  to  perform  the  routine  duties  of  Assistant  Superintendents. 

All  patients  entering  the  Hospital,  whether  applying  to  the  Admitting 
Physicians,  referred  from  the  Out-Patient  Department,  brought  by  ambu- 
lance, sent  by  members  of  the  Visiting  Staff,  or  transferred  from  other  hos- 
pitals, pass  through  the  admitting  office,  except  insane  patients,  who  are 
taken  directly  to  the  psychopathic  ward  and  the  necessary  records  made 
afterward. 

The  Admitting  Physicians  enter  a  preliminary  history  of  the  patients. 
The  patients  are  then  sent  to  the  bathroom  and  subsequently  to  the  wards 
to  which  the  Admitting  Physician  has  assigned  them.  In  designating  the 
ward  to  which  a  patient  is  to  be  sent  the  admitting  office  is  governed  by  a 
rule  requiring  patients  to  be  assigned  in  rotation  to  the  four  Divisions  of  the 
Hospital.  This  system  of  rotation  does  not  apply  to  patients  admitted  dur- 
ing the  night,  the  latter  being  assigned  to  wards  with  vacant  beds.  In 
other  words,  they  are  assigned  in  the  discretion  of  the  Admitting  Physician 
on  night  duty.  Patients  bringing  requests  for  admission  from  one  of  the 
Divisions  of  the  Out-Patient  Department  or  from  a  member  of  the  Attend- 
ing Staff  are  excepted  from  rotation,  and  sent  to  the  Division  from  which 
the  request  emanated.  These  requests  are  sent  to  the  Superintendent  for 
approval  before  the  patients  are  admitted. 

No  patients  are  rejected  because  of  their  financial  status.  Inquiry  is 
made  as  to  the  earnings  of  applicants  and  a  record  made  on  the  history 
card.  Some  of  these  cases  are  afterward  questioned  by  the  Hospital  in- 
vestigators, and  sometimes  the  home  conditions  are  investigated.  The  pro- 
portion of  cases  that  pay  for  care  in  the  Hospital  is  very  small,  so  small  as 
to  be  negligible. 

Discharge  of  Patients 

Under  the  rules  of  the  Hospital,  House  Physicians  and  Surgeons  may 
discharge  responsible  patients  upon  their  own  request ;  they  may  discharge 
irresponsible  patients  at  the  request  of  accredited  friends,  obtaining  a  signed 
release;  they  may  discharge  patients  when  directed  by  their  respective 
Visiting  Physicians  or  Visiting  Surgeons.  In  all  these  cases  it  is  provided 
that  the  form  of  discharge  must  be  accepted  by  the  Superintendent.  As  far 
as  can  be  ascertained  by  inquiry  the  practice  is  for  the  Senior  House  Phy- 
sician or  Surgeon  on  duty  in  a  given  service  to  discharge  patients,  the  form 
being  sent  to  the  Superintendent  for  signature.  In  some  cases  the  Senior 
House  Physician^consults  the  Visiting  Physician  in  regard  to  discharge.  It 
is  evident  that  the  routine  discharge  of  patients  is  controlled  by  the  House 
Staff,  the  function  of  the  Superintendent  in  this  respect  being  merely  for- 
mal and  confined  to  the  signature  of  the  form ;  he  is  not  required  or  author- 
ized to  determine  the  fitness  of  the  patient  for  discharge.  It  will  be  noticed 
that  the  House  Physicians  and  Surgeons  have  had  but  18  months  service 
previous  to  being  intrusted  with  this  function. 


732 


HOSPITAL   COMMITTEE 


These  internes  are  in  the  Hospital  primarily  for  study  and  observation. 
They  desire  to  see  as  many  cases,  and  as  many  different  kinds  of  cases,  as 
possible.  Prompted  by  this  desire,  their  tendency  is  to  discharge  prema- 
turely patients  in  whom  they  have  little  interest,  and  inasmuch  as  they  are 
not  responsible  to  the  Hospital  as  an  organization,  this  tendency  is  but  little 
restrained.  With  these  internes  responsible  only  to  the  Visiting  Staff,  it 
would  be  very  difficult  for  the  Hospital  to  adopt  and  carry  out  any  broad 
program  of  care  and  treatment.  The  policy  of  the  Hospital  with  regard  to 
the  length  of  treatment  is  thus  largely  regulated  by  these  inexperienced 
internes,  who  are  looking  for  new  and  interesting  cases. 

The  only  class  of  patients  whose  stay  in  the  Hospital  the  Superintendent 
of  the  Hospital  regulates  is  the  class  of  patients  who  have  remained  in  the 
Hospital  3  months  or  longer.  Each  month  a  report  is  made  to  the  Super- 
intendent of  the  patients  who  have  been  in  the  institution  3  months,  and, 
thereupon,  an  examination  is  made  by  the  Superintendent  or  his  assistants, 
and  a  decision  is  rendered  as  to  whether  such  patients  should  remain  or  be 
discharged.  This  rule  is  adequate  to  regulate  the  maximum  stay  of  pa- 
tients, but  the  Hospital  authorities  seem  to  have  little  or  no  control  over 
the  minimum  stay. 


Results  of  the  Existing  System  of  Medical  Service  in  Bellevue 

It  seemed  desirable  to  ascertain,  as  far  as  possible,  the  results  of  the 
medical  practice  in  Bellevue  Hospital.  It  appeared  highly  inadvisable  to 
attempt  to  secure  the  opinion  or  judgment  of  any  physicians  as  to  the  results 
of  the  work  of  other  physicians  attached  to  the  Bellevue  staff,  as  such  judg- 
ments would  be  difficult  to  secure,  and  when  secured  would  be  given  little 
credence. 

As  a  method  of  test  it  was  decided  to  make  an  examination  of  the  records 
in  the  Hospital  in  so  far  as  such  records  might  throw  light  upon  the  probable 
condition  of  patients  on  discharge  and  the  attention  that  may  have  been 
given  patients  while  in  the  Hospital.  With  this  purpose  in  view,  the  records 
of  all  lower  extremity  fracture  cases  that  had  been  discharged  from  Belle- 
vue during  the  year  1912  were  examined.  The  cases  were  tabulated  under 
the  following  classifications  :  fracture  of  the  ankle ;  femur ;  foot ;  leg :  patella. 
The  number  of  cases  under  each  classification  was  recorded  according  to 
the  length  of  time  they  had  remained  in  the  Hospital,  being  listed  under 
those  that  stayed  i  day ;  2  days ;  3  days ;  4  to  5  days ;  6  to  7  days ;  8  to  12 
days ;  13  to  21  days ;  22  to  31  days ;  32  to  61  days ;  62  to  92  days ;  93  to  123 
days;  124  to  183  days;  184  to  365  days.  By  this  method  of  tabulation  it 
was  easy  to  determine  the  percentage  of  cases  that  were  discharged  within 
a  given  time. 

All  cases  readmitted  one  or  more  times  during  the  year  1912  were  ex- 
amined and  classified  in  various  ways,  to  determine  what  proportion  re- 
ceived a  diagnosis  on  a  subsequent  admission  differing  from  that  recorded 
at  a  previous  discharge.  These  readmissions  were  also  classified  on  the 
basis  of  the  incubation  period  for  various  diseases. 

The  homes  of  about  one  thousand  patients  discharged  from  Bellevue 
during  1912  were  visited,  to  determine  the  apparent  condition  of  patients  on 
discharge  and  what  happened  to  them  subsequent  to  discharge ;  whether  they 
recovered,  and,  if  so.  within  what  period;  whether  they  received  subsequent 
treatment  by  private  physicians  or  by  another  hospital ;  or  whether  they  re- 


REORGANIZATION   OF   MEDICAL   SERVICE  733 

turned  to  Bellevue  a  second  time.  This  inquiry  also  showed  the  condition 
of  the  homes  into  which  patients  were  discharged ;  whether  or  not  the 
home  was  a  suitable  place  for  a  convalescing  patient ;  and  whether  the  finan- 
cial status  of  the  family  was  such  as  to  enable  them  to  support  a  member 
of  the  family  unable  to  work. 

The  number  of  visits  made  by  each  member  of  the  Visiting  Staff  and 
the  time  spent  in  the  Hospital  were  taken  from  the  records  and  tabulated  so 
as  to  show  the  average  time  rendered  to  the  patients  by  the  staff  of  the  dif- 
ferent Divisions  in  the  Hospital. 

The  records  of  Bellevue  were  examined  for  the  year  1912,  to  determine 
the  average  length  of  stay  of  different  classes  of  cases,  and  the  results  were 
tabulated  according  to  the  Divisions  of  the  Hospital.  These  tabulations 
showed  not  only  the  average  length  of  time  patients  stayed  in  the  Hospital, 
but  also  the  number  discharged  after  remaining  in  the  Hospital  i  day,  2 
days,  3  days,  etc.  In  order  to  examine  these  records  it  was  necessary  to 
make  a  complete  transcript  of  nearly  20,000  cards  and  to  examine  fully 
300,000  records. 

It  is  probable  that  the  conditions  in  Bellevue  are  not  worse  than  in  a 
large  proportion  of  our  good  hospitals.  If  any  of  our  high-class  hospitals 
were  examined  in  detail  many  things  would  be  found  which  should  be  cor- 
rected, and  which  the  attending  physicians  would  readily  admit  should  not 
have  occurred.  However,  these  facts,  set  forth  in  connection  with  those  in 
Section  III,  have  seemed  to  the  Committee  of  such  import  as  to  warrant  a 
recommendation  for  a  rather  radical  reorganization  of  the  medical  service 
in  Bellevue  Hospital.  The  main  conclusions  arrived  at  from  these  facts 
may  be  summarized  somewhat  as  follows : 

1.  The  diagnosing  of  cases  has  been  less  thorough  and  less  accurate 
than  should  have  been  expected,  owing  in  part  to  insufficient  time  rendered 
to  the  Hospital  by  the  attending  physicians  and  in  part  to  too  great  a  trust 
in  inexperienced  internes. 

2.  A  few  of  the  attending  physicians  have  been  present  at  all  autopsies 
pertaining  to  their  respective  Divisions,  while  most  of  them  have  attended 
but  few  autopsies,  which  fact  indicates  an  insufficient  interest  in  the  accuracy 
or  inaccuracy  of  their  clinical  diagnoses. 

3.  Internes  have  been  permitted  to  discharge  patients  without  the 
knowledge  of  the  attending  staff,  and  in  many  cases  these  patients  were 
either  not  in  proper  condition  to  be  discharged,  or  were  discharged  to  homes 
unfit  for  their  reception. 

4.  The  internes  have  been  primarily  interested  in  seeing  new  and  inter- 
esting cases,  and,  accordingly,  have  too  often  discharged  cases  which  were 
uninteresting,  though  still  in  need  of  hospital  treatment. 

5.  The  Social  Service  Department  of  the  Hospital  has  received  notifica- 
tion of  the  discharge  of  comparatively  few  patients,  and  little  cooperation 
exists  between  the  discharging  staff  and  the  Social  Service  Department, 
with  the  result  that  little  attempt  has  been  made  to  gain  information  as  to 
the  condition  of  the  homes  into  which  patients  are  discharged. 

6.  Clinical  histories  and  records  have  been  so  carelessly  and  inade- 
quately kept  that  they  have  been  of  comparatively  little  service  in  the  treat- 
ment of  cases  on  the  first  or  subsequent  readmissions. 

7.  Owing  to  the  comparatively  small  amount  of  time  rendered  to  the 
Hospital  by  the  attending  physicians  little  scientific  work  has  been  done, 
and  the  pathological  material  has  been  but  little  used. 


734  HOSPITAL   COMMITTEE 

8.  The  system  of  rotating  services  for  the  Visiting  Staff  has  militated 
against  good  treatment  of  patients. 

9.  The  method  of  examining  internes  on  entering  the  Hospital,  by  the 
college  Divisions  rather  than  by  the  Hospital,  has  made  the  internes  feel  that 
they  are  officers  of  the  college  Divisions  rather  than  of  the  Hospital.  This 
condition  has  made  it  difficult  for  the  Hospital  to  carry  out  any  consistent 
policy  which  might  to  some  extent  interfere  with  the  interests  of  the  in- 
ternes. 

10.  The  internes  have  not  received  the  diagnostic  training  that  they 
should  have  received,  owing  to  the  fact  that  they  have  been  thrown  too 
largely  upon  their  own  resources  rather  than  guided  by  the  attending  staff. 

Bellevue  has  offered  a  splendid  opportunity  for  internes  to  practice,  but 
to  practice  with  too  little  guidance  on  the  part  of  trained  and  competent 
physicians. 

The  primary  object  of  Bellevue  Hospital,  as  well  as  other  hospitals, 
should  be  to  properly  and  adequately  care  for  the  sick.  Its  form  of  or- 
ganization, its  methods  of  administration,  its  regulations  should  all  be 
directed  toward  accomplishing  efficiently  this  primary  purpose. 

After  years  of  experience,  it  has  been  found  that  patients  are  better 
cared  for  in  hospitals  where  teaching  is  done  than  in  hospitals  where  none 
is  carried  on.  The  King  Edward  Hospital  Fund  Committee  of  London, 
appointed  to  investigate  the  relation  of  the  hospitals  to  the  medical  colleges, 
after  a  searching  and  painstaking  inquiry  came  to  the  unanimous  conclusion 
that  patients  were  much  better  cared  for  in  hospitals  wherein  medical  schools 
did  teaching  than  in  hospitals  which  were  not  served  by  such  schools.  It 
seems  to  be  generally  conceded  that  the  medical  service  in  Bellevue  Hospital 
is  improved  by  the  attendance  of  a  visiting  staff  largely  selected  from  the 
medical  colleges.  The  reciprocal  relation  existing  between  Bellevue  and  the 
medical  colleges  is  of  benefit  both  to  the  patients  and  to  the  colleges. 

The  City  has  the  right  to  ask,  however,  not  only  whether  patients  are 
better  treated  because  of  the  service  rendered  by  the  medical  colleges,  but 
also  whether  or  not  these  schools  at  the  same  time  are  using  the  clinical 
material  to  the  best  advantage  for  the  furtherance  of  medical  education. 
Inasmuch  as  the  City  furnishes  and  maintains  an  expensive  hospital  plant, 
wherein  is  one  of  the  best  equipped  pathological  laboratories  of  the  world, 
it  is  just  that  any  medical  college  having  the  privilege  of  serving  therein 
should  be  required  to  use  the  facilities  to  the  very  best  advantage.  That 
the  medical  colleges  have  not  improved  these  advantages  as  they  might  have 
done  is  readily  apparent.  The  attending  physicians,  most  of  whom  are  in- 
structors in  the  medical  colleges,  have  not  rendered  the  amount  of  time  in 
the  Hospital  necessary  to  properly  instruct  the  students  in  diagnosing  cases ; 
they  have  not  experimented  sufficiently  as  to  means  of  alleviating  or  curing 
disease;  they  have  not  made  the  close  scientific  study  of  the  causes  of  dis- 
ease that  should  have  been  made.  Inasmuch  as  knowledge  as  to  the  causes 
and  progress  of  disease  will  tend  to  preserve  and  guard  the  health  of  all 
citizens,  New  York  City  should  so  operate  its  hospitals  that  the  sick  cared 
for  therein  shall  add  to  medical  knowledge. 

Prompted  by  the  fact  that  the  medical  service  in  Bellevue  Hospital  is 
inadequate,  and  that  the  opportunities  for  study  oflfered  by  the  large  number 
of  patients  and  the  expensive  equipment  are  not  being  adequately  utilized, 
the  Committee  has  deemed  it  advisable  to  recommend  a  radical  reorganiza- 
tion of  the  medical  service.    The  Committee  recognizes  that  the  physicians 


REORGANIZATION   OF  MEDICAL   SERVICE  735 

and  surgeons  who  have  given  their  time  voluntarily  have  rendered  a  great 
service  to  the  sick  of  the  City,  and  it  is  regretted  that  it  seems  necessary  to 
suggest  a  reorganization  which  will  result  in  subordinating  many  of  these 
men  to  a  paid  chief,  should  they  continue  to  serve  in  the  Hospital.  It  is  be- 
lieved, however,  that  most  of  these  men  appreciate  the  fact  that  physicians 
and  surgeons  burdened  with  a  large  private  practice  cannot  give  the  time 
required  to  promote  the  best  interest  of  the  patients  and  the  most  rapid 
advancement  of  medical  education.  They  recognize  that  there  must  be 
directing  heads  to  the  Services  who  can  devote  a  large  portion  of  their  time 
to  close  clinical  and  scientific  work  in  the  Hospital. 

The  recommendations  of  the  Committee  with  regard  to  the  reorganiza- 
tion of  the  medical  service  in  Bellevue  are  as  follows: 


Plan  of  Reorganization 

Control  to  remain  in  a  Board  of  Trustees,  to  which  shall  be  delegated 
power  to  determine  general  matters  and  policies.  Such  Board  to  ap- 
point a  Superintendent  for  a  prescribed  period  of  years,  who  shall 
have  full  administrative  control  of  the  Hospital  and  Out-Patient 
Department. 

Control  of  admissions,  distribution,  discharges,  and  social  service  to  be 
under  the  charge  of  the  Superintendent. 

Present  Medical  Board  to  be  supplanted  by  an  Advisory  Committee  con- 
stituted as  follows;  the  Chiefs  of  the  Medical  Services,  the  Chiefs  of 
the  Surgical  Services,  the  Director  of  Laboratories,  and  the  Superin- 
tendent :  such  Committee  to  have  no  power  other  than  advisory.  (Four 
Medical  and  four  Surgical  Services  representing  three  medical  colleges 
and  one  open  Division.) 

The  Out-Patient  Department  to  be  an  integral  part  of  the  Hospital,  both 
from  an  administrative  and  a  medical  standpoint;  the  medical  and 
surgical  attendants  of  each  Division  of  the  Out-Patient  Department 
to  be  appointed  by  the  Trustees  on  nomination  by  the  medical  and 
surgical  Chiefs  of  the  respective  Divisions  of  the  Hospital  and  the 
Advisory  Committee. 

Each  medical  school  to  be  required  to  furnish  a  continuous  service  by 
means  of  a  paid  Chief  of  its  Medical  and  also  of  its  Surgical  Service ; 
such  Chiefs  to  be  paid  in  part  by  the  medical  schools,  the  City  to  pay 
one-half  of  the  salary  when  such  half  does  not  exceed  $2,500  per 
year;  heads  of  the  Fourth  Division  to  be  nominated  by  the  Council 
of  the  Academy  of  Medicine  and  the  entire  salary  paid  by  the  City; 

I  such  Chiefs  to  be  appointed  for  a  term  of  years  and  to  serve  in  the 
Hospital,  on  an  average,  not  less  than  one-half  of  each  day;  an  age 
of  retirement  to  be  established;  a  service  of  attending  physicians 
and  surgeons  associated  with  such  Chiefs  to  be  provided  for ;  nomina- 
tions of  the  attending  staff  for  each  Division  to  be  made  by  the  re- 
spective Chiefs  of  such  Divisions  and  by  the  Advisory  Committee; 
special  services  to  be  assigned  to  the  various  Divisions  for  designated 
periods,  with  some  possible  exceptions ;  all  nominations  to  be  submitted 
to  the  Board  of  Trustees  for  approval. 


736  HOSPITAL  COMMITTEE 

6.  A  Resident  Physician  for  the  Medical  Service  and  a  Resident  Surgeon 
for  the  Surgical  Service  of  each  Division  to  be  employed ;  one-half 
of  the  salary  of  such  Residents  to  be  paid  by  the  City  and  one-half  by 
the  respective  medical  schools ;  appointments  for  such  positions  to  be 
made  for  a  specified  term  by  the  Trustees  on  nomination  by  the  Chiefs 
of  the  respective  Services  and  the  Advisory  Committee. 

7.  Internes  to  be  nominated  by  the  Advisory  Committee,  after  an  examina- 
tion held  by  the  Committee,  the  form  of  which  to  be  approved  by  the 
Board  of  Trustees ;  the  appointment  to  be  made  by  the  Trustees ;  the 
results  of  the  examination  to  be  made  a  matter  of  record. 

8.  The  Trustees  to  reserve  the  power  to  discontinue,  for  cause,  the  services 

of  any  medical  officer,  chief  of  service,  resident  or  attendant  physician, 
surgeon,  pathologist,  or  interne,  whether  paid  or  unpaid ;  if  paid, 
whether  paid  by  a  college  or  by  the  Hospital  or  partly  by  both. 

9.  In  the  Pathological  Department,  the  salary  of  the  Director  of  Labora- 

tories to  be  paid  by  the  City ;  his  functions  and  duties  to  be  as  follows : 

(a)  To  have  general  supervision  of  all  laboratories  connected  with 

the  Hospital  and  all  the  work  carried  on  therein. 

(b)  To  keep  all  records  of  findings. 

(c)  To  perform  or  control  the  performance  of  all  autopsies. 

(d)  To  control  the  use  of  all  organs  and  tissues. 

(e)  To  direct  the  work  of  the  pathologists  assigned  by  the  colleges. 

Each  college  Division  to  nominate  a  Pathologist  whose  appointment  shall 
be  subject  to  the  approval  of  the  Director  of  Laboratories  and  the  Trustees 
of  the  Hospital ;  the  salary  of  such  Pathologists  to  be  paid  by  the  respective 
colleges,  and  to  be  not  less  than  $1,500  per  year;  the  entire  time  of  these 
Pathologists  to  be  devoted  to  work  at  the  Hospital ;  the  amount  of  teaching 
and  research  work  to  be  carried  on  to  be  regulated  by  the  respective  colleges, 
subject,  however,  to  necessary  routine  work  assigned  by  the  Director  of 
Laboratories. 


Argument  in  Support  of  the  Plan  of  Reorganization 

I.    Control  to  Remain  in  a  Board  of  Trustees 

A  single  head,  when  competent,  is  always  more  efficient  than  a  directing 
board.  A  board  cannot  be  a  successful  administrative  body.  Could  we  be 
assured  of  the  selection  by  each  succeeding  Mayor  of  a  competent  commis- 
sioner for  Bellevue  and  Allied  Hospitals,  a  board  of  trustees  should  not 
be  given  consideration.  The  Bellevue  Board  of  Trustees  has  been  but  par- 
tially successful,  as  shown  by  the  investigation  of  this  Committee.  It  has, 
however,  raised  the  standard  of  hospital  practice  in  a  noteworthy  degree,  but 
greater  efficiency  would  have  resulted  had  it  confined  itself  to  a  determination 
of  general  policies  and  measures  and  held  the  Superintendent  strictly  respon- 
sible for  results.  It  has  established  very  few  forms  of  reports  designed  to 
give  information  as  to  the  success  or  failure  of  the  various  functions  per- 
formed in  the  Hospitals.    The  shortcomings  noted  in  Bellevue  are  attributa- 


REORGANIZATION   OF  MEDICAL  SERVICE  737 

ble  to  the  above  causes  and  not  to  causes  inherent  in  a  board  of  trustees 
as  such. 

Boards  of  trustees  as  governing  boards  of  large  corporations  are  a  suc- 
cess. A  board  of  trustees  can  be  a  successful  controlling  body  for  Bellevue 
and  Allied  Hospitals  if  it  will  control  as  do  the  corporation  boards ;  viz.,  by 
confining  itself  to  appointments,  policies,  and  measures,  and  by  requiring 
reports  which  will  inform  as  to  results. 

If  the  Department  of  Bellevue  and  Allied  Hospitals  is  to  remain  a  sepa- 
rate department  it  is  perhaps  advisable  to  continue  the  Board  of  Trustees, 
but  with  restricted  powers. 

2.  Control  of  Admissions,  Distribution,  Discharges,  and  Social  Service 

The  Superintendent  nominally  controls  admissions  through  admitting 
officers  employed  by  the  Hospital.  In  practice  this  control  is  but  partial,  for 
the  discharges  are  in  the  hands  of  the  House  Staff,  and  in  seasons  when 
there  is  pressure  upon  the  service  patients  are  assigned  to  the  Services 
which  have  the  most  vacancies.  Many  vacancies  are  made  by  premature 
discharges,  so  that  the  admissions  are  in  a  degree  regulated  by  the  discharges 
made  by  the  House  Staff. 

There  have  been  no  transfers  between  Divisions.  Many  vacant  beds  have 
at  times  existed  in  one  Division  when  another  was  overcrowded,  and  there 
have  been  no  transfers  from  Surgical  to  Medical  Service  for  better  adjust- 
ment. 

All  of  these  matters  should  be  controlled  by  the  Superintendent. 

3.  Advisory  Committee  to  be  Established  for  Medical  Board 

The  powers  of  the  Medical  Board  recognized  by  the  City  Charter  were 
transferred  in  1913  to  an  Executive  Committee.  The  functions  of  the  Ex- 
ecutive Committee  as  now  constituted  are  similar  to  those  of  the  proposed 
Advisory  Committee. 

4.  The  Out-Patient  Department  to  be  an  Integral  Part  of  the  Hospital 

That  about  25  per  cent,  of  the  patients  admitted  to  the  Hospital  remain 
less  than  72  hours  argues  that  a  large  number  of  patients  now  admitted  to 
the  Hospital  could  be  cared  for  in  the  Out-Patient  Department,  were  it 
properly  correlated  with  the  Hospital.  It  should  be  possible  for  a  physician 
of  the  Out-Patient  Department  to  place  a  patient  in  the  Hospital  for  diagno- 
sis under  his  own  direction,  but  at  present  this  is  done  in  a  very  limited 
degree.    Little  argument  is  needed  to  support  the  need  for  such  correlation. 

5.  Medical  Schools  to  Provide  Paid  Chiefs  of  Services 

Diagnosing  to-day  is  a  process  much  more  complicated  than  in  the  days 
when  judgment  was  based  chiefly  on  pulse,  temperature,  tongue,  color,  etc. 
The  diagnostician  must  make,  or  have  made,  various  blood  and  secretion 
tests,  which  involve  time,  technical  knowledge,  and  skill.  More  time  is  given 
to  patients,  resulting  in  a  larger  percentage  of  correct  diagnoses  than 
formerly.  We  are  demanding  for  the  patients  in  our  City  hospitals  as  good 
care  and  treatment  as  are  given  to  private  patients,  which  was  not  the  case 
some  years  ago.  These  changed  conditions  demand  from  the  staffs  of 
municipal  hospitals  much  time,  but  the  time  thus  given  by  the  attending 


738  HOSPITAL  COMMITTEE 

staffs  limits  the  amount  allowed  for  private  practice.  Owing  to  the  neces- 
sity of  spending  more  time  with  the  patients  in  the  hospitals  the  number  of 
attending  physicians  has  been  increased  so  as  to  require  but  a  reasonable 
amount  of  time  from  each.  The  increase  in  the  number  on  the  staffs  has 
scattered  responsibility,  not  only  as  between  a  number  of  rotating  visiting 
and  assistant  visiting  physicians,  but  also  as  between  these  heads  and  the 
house  staffs.  Treatment  begun  under  one  head  may  be  transferred  in  turn 
to  two  or  more  physicians  before  the  termination  of  the  case. 

Good  work  cannot  be  done  without  centering  responsibility  upon  one 
man  who  is  able  to  give  sufficient  time  to  supervise  processes  and  check 
results.  The  amount  of  time  thus  required  cannot  be  given  by  a  physician 
who  must  secure  his  living  by  maintaining  a  private  practice.  More  time 
must  be  given  than  has  been  given,  and  when  rendered  should  be  paid  for. 

The  medical  profession  in  Germany  has  advanced  beyond  the  profession 
in  this  country  in  diagnosing.  This  advance  in  Germany  is  largely  attribut- 
able to  the  paid  chiefs  of  services  in  the  state  and  municipal  hospitals.  A 
description  of  this  paid  service  is  fully  set  forth  in  "Medical  Education  in 
Europe,"  by  Abraham  Flexner.  Opinions  of  leading  physicians  in  this 
country  with  regard  to  a  paid  service  will  be  found  in  the  appendix  on 
pages  741  to  759.  The  experience  in  Germany  and  in  Johns  Hopkins  Hos- 
pital, and  the  opinions  of  leading  physicians  referred  to,  all  point  to  the 
advisability  of  a  paid  service. 

However,  the  plan  for  Bellevue  Hospital  as  proposed  by  this  Com- 
mittee provides  that  the  salaries  of  the  Chiefs  shall  be  not  less  than  $5,000, 
half  of  which,  but  not  exceeding  $2,500,  to  be  paid  by  the  City. 

In  the  opinion  of  many  of  those  most  competent  to  speak  this  salary 
will  secure  half  of  the  time  of  the  most  competent  physicians  and  surgeons. 
Half  of  the  time  of  the  Chiefs  may  be  devoted  to  consultation  practice, 
which  will  give  them  a  larger  experience  with  the  early  stages  of  diseases 
not  usually  found  in  hospitals. 

As  long  as  the  Fourth  Division  exists  it  will  be  necessary  for  the  City 
to  pay  the  full  salary  of  the  Chiefs.  However,  there  appear  to  be  some 
good  reasons  for  abolishing  this  Division,  but  this  action  is  not  recom- 
mended at  the  present  time. 

6.  Provision  for  Resident  Physicians  and  Surgeons 

Many  of  the  shortcomings  in  our  hospitals  are  attributable  to  the  com- 
paratively inexperienced  house  physicians  and  surgeons.  These  men,  who 
are  in  sole  charge  of  the  patients  in  the  absence  of  the  chiefs,  should  be 
experienced  men.  Moreover,  the  Chiefs  should  have  assistants  whom  they 
can  trust  to  carry  out  instructions  intelligently  and  accurately.  To  secure 
these  conditions  paid  men  are  necessary.  So  few  will  disagree  with  this 
provision  that  little  argument  is  needed. 

7.  Internes  to  be  Officers  of  the  Hospital  Rather  than  the  College 

Division 

Few  will  dissent  from  the  contention  that  the  internes  should  be  chosen 
for  the  whole  Hospital  by  one  examination,  and  that  when  chosen  they 
should  represent  the  Hospital  management  rather  than  the  colleges.  The 
internes  may  be  more  nearly  classed  with  the  nursing  staff  than  with  the 
medical  service.     According  to  the  proposed  plan  the  medical  and  surgi- 


REORGANIZATION    OF  MEDICAL  SERVICE  739 

cal  treatment  is  delegated  by  the  Hospital  to  the  colleges.  The  nursing  or 
care  of  the  patients  is  retained  under  the  supervision  of  the  Hospital. 
Since  the  Hospital  is  and  must  remain  responsible  for  the  proper  care  of 
the  patients,  the  internes,  as  a  part  of  the  nursing  service,  should  be  re- 
sponsible primarily  to  the  Hospital. 

8.  The  Trustees  to  Discharge  for  Cause 

The  City  must  retain  full  control  of  its  hospitals,  and  cannot  do  so 
without  reserving  the  right  to  discharge  any  officer  who  may  not  measure 
up  to  the  standards  set  by  the  hospitals. 

9.  The  Pathological  Department 

The  Pathological  Department  performs  several  functions:  first,  by 
autopsies  it  checks  the  accuracy  of  the  clinical  diagnoses  of  the  physicians 
— this  function  of  the  Department  must  be  under  the  control  of  the  Hos- 
pital; second,  it  may  do  work  required  in  connection  with  clinical  diagnos- 
ing— this  is  primarily  work  of  the  colleges;  third,  it  may  do  work  of 
original  investigation — this  may  be  work  of  the  colleges  or  of  the  Hos- 
pital, according  to  the  policy  of  the  Hospital.  The  functions  which  are 
or  may  be  performed  by  the  Pathological  Department  are  not  possible  of 
clear  definition  at  the  present  time,  except  in  so  far  as  they  apply  to 
autopsies.  These  clearly  must  be  controlled  by  the  Hospital.  Likewise 
the  tissues,  as  a  part  of  the  bodies  to  be  conserved,  must  be  controlled  by 
the  Hospital.  The  Pathological  Department,  in  so  far  as  it  deals  with 
bodies  or  tissues,  must  be  under  the  control  of  the  Hospital.  This  condi- 
tion makes  it  necessary  that  all  officers  in  the  Pathological  Department 
should  be  under  the  control  of  the  Director  of  Laboratories.  Inasmuch 
as  the  colleges  desire  to  do  teaching  of  gross  pathology  in  connection  with 
autopsies,  it  seems  reasonable  that  each  should  furnish  and  pay  the  salary 
of  such  teacher  and  demonstrator. 


APPENDIX 

TO 

PROPOSED  REORGANIZATION  OF  THE  MEDICAL  SERVICE 

IN  BELLEVUE  HOSPITAL 

During  the  process  of  formulating  a  plan  for  the  reorganization  of 
the  medical  service  of  Bellevue  Hospital  many  local  physicians  were  con- 
sulted, and  the  tentative  drafts  were  modified  many  times  as  a  result  of 
these  conferences.  After  the  plan  had  reached  about  the  form  in  which  it  is 
now  presented  it  v/as  sent  to  some  of  the  leading  physicians  throughout 
the  country  for  further  expression  of  opinion,  and  as  a  result  of  these 
opinions  some  minor  modifications  were  made.  The  letters  of  these  eminent 
physicians  are  deemed  worthy  of  record  and  are  set  forth  in  part  here- 
with. 

Letter  Transmitting  to  Physicians  Tentative  Draft  of  Plan 

Dear  Dr.  . 

I  take  the  liberty  of  sending  you  a  draft  of  a  suggested  reorganization 
of  the  medical  service  of  Bellevue  Hospital,  of  this  City.  It  was  drafted 
by  this  Committee  after  consultation  with  a  number  of  the  leading  medical 
men  of  the  country,  and  we  desire  to  secure  some  further  opinions  with 
regard  to  the  advisability  of  substituting  some  such  form  of  reorganiza- 
tion for  the  plan  of  voluntary  and  rotating  service  now  in  operation.  I 
shall  highly  appreciate  it  if  you  will  express  your  opinion  with  regard  to 
the  plan.  If  agreeable,  will  you  please  cover  the  following  points  in  your 
reply : 

1.  Do  you  consider  a  paid  service  preferable  to  a  voluntary  service, 
and  if  so,  why? 

2.  Does  the  plan  provide  an  acceptable  means  of  securing  a  paid 
service  ? 

3.  Do  you  consider  the  proportions  of  the  salaries  of  the  Chiefs  of 
the  Services  provided  in  the  plan  fair  both  to  the  colleges  serving  in  the 
Hospital  and  also  to  the  City? 

4.  What  objections  do  you  find  to  the  plan  as  outlined? 

I  shall  be  glad  to  have  you  express  your  opinion  on  the  plan,  without 
regard  to  local  conditions  at  Bellevue  Hospital,  and  without  regard  to 
consideration  as  to  whether  or  not  the  present  is  an  opportune  time  for 
putting  it  into  operation. 

I  shall  consider  it  a  great  favor  if  you  will  give  us  your  opinion  and 
also  permit  us  to  quote  it  if  it  seems  to  us  advisable. 

Sincerely  yours, 

Henry  C.  Wright, 

Director  of  Investigation     , 

741 


Extracts  from  Letters 

(Written  in  the  month  of  December,  1913) 


Dr.  Charles  H.  Frazier 
Philadelphia 

1.  I  believe  that  hospitals  should  give  some  money  compensation  for  service 
rendered,  not  that  it  will  obtain  in  this  way  a  higher  grade  or  a  better  physician,  but 
it  enables  the  hospital  to  demand  more  time  of  the  attending  staff  than  it  is  justified 
in  doing  when  services  rendered  are  purely  voluntary. 

2.  The  general  plan  of  concentrating  the  responsibility  of  the  several  services  of 
the  Hospital  in  the  hands  of  a  few,  and  more  particularly  of  affording  to  the  staff 
a  continuous  service  throughout  the  year,  is  an  excellent  one  and  calls  for  nothing  but 
meritorious  comment.  I  see  no  reason  why  under  the  plan  you  have  proposed  you 
should  not  obtain  a  group  of  capable  men  between  the  ages  of  thirty-five  and  forty 
who  would  be  only  too  glad  to  give  half  of  their  day  to  the  Hospital  with  adequate 
compensation  and  ample  time  for  private  practice. 

3.  The  salary  question  is  a  more  difficult  one,  and  perhaps  there  are  conditions 
in  New  York  with  reference  to  the  relation  of  the  hospital  to  the  school  with  which 
I  am  not  familiar.  I  believe,  however,  that  in  course  of  time  you  will  find  that  the 
salaries  will,  and  ought  to,  be  paid  altogether  by  the  City. 

4.  I  have  no  objections  to  the  plan  as  outlined,  and  I  am  delighted  to  know 
that  it  will  soon  be  put  in  operation.  I  happen  to  have  been  responsible  for  the 
adoption  of  a  similar  plan  on  a  very  small  scale  at  the  Episcopal  Hospital  in  Phila- 
delphia, where  we  reorganized  the  out-patient  department  and  have  on  duty  two 
salaried  physicians,  with  necessary  assistants  throughout  the  year. 

Dr.  Frank  Billings 
Chicago 

I  consider  a  paid  service  in  a  hospital  preferable  to  a  volunteer  service.  I  believe 
this  to  afford  better  service  to  the  hospital  because  a  paid  service  must  necessarily 
imply  a  required  daily  attendance  of  the  physician  and  surgeon  at  a  fixed  time.  Under 
no  other  conditions,  probably,   would  an  adequate  time  service  be  given. 

The  salaries  of  chiefs  of  staff  need  not  be  large  and  the  sum  named  in  the 
outline  of  the  plan  submitted  is,  I  think,  sufficiently  large  as  the  salary  of  chiefs  of 
departments.  For  associates  and  assistant  attending  physicians  and  surgeons  I  think 
the  salary  paid  should  be  sufficient  to  interest  these  attendants,  and  it  need  not  be  a 
large  sum. 

Second :  I  think  the  plan  provides  an  acceptable  means  of  securing  a  paid  service. 
The  plan  as  I  understand  it  is  that  the  medical  schools  of  New  York  shall  have  three 
Divisions  of  the  Medical  Service  and  three  Divisions  of  the  Surgical  Service,  which 
will  afford  an  opportunity  to  use  the  Hospital  as  a  teaching  institution,  a  service  which 
is  absolutely  necessary  provided  the  medical  management  remains  at  a  high  standard. 

Third :  I  cannot  answer  the  third  question  as  to  whether  the  plan  provided  for 
the  payment  of  the  salaries  by  the  colleges  and  by  the  City  is  fair  and  equable. 

The  medical  service  in  a  hospital  is  for  the  benefit  of  patients,  and,  therefore,  if 
properly  administered  is  a  service  entirely  for  a  city.  The  fact  that  the  medical 
schools  have  the  privilege  of  using  the  Hospital  as  a  part  of  their  teaching  facilities 
does  not  necessarily  mean  that  the  medical  schools  should  pay  any  part  of  the  salary, 
for  I  believe  that  the  service  is  made  so  much  better  by  the  fact  that  the  Hospital  is 
a  teaching  institution  that  it  is  a  real  economy  to  the  City.  In  other  words,  I  think 
it  pays  the  City  to  permit  the  medical  schools  to  use  Bellevue  Hospital,  for  by  so 
doing  the  patients  are  more  thoroughly  examined,  aiid  better  managed  than  they  would 
be  if  there  was  not  the  constant  inspection  and  criticism  oilered  by  the  presence  of 
students.  This  probably  also  means  a  shorter  stay  in  the  Hospital  of  many  patients 
and  a  real  economy  to  the  City. 

743 


744  HOSPITAL   COMMITTEE 

At  the  same  time,  if  the  medical  schools  agree  to  enter  into  a  plan  by  which  they 
shall  pay  half  the  salaries  there  can  be  no  objection  to  it. 

Fourth:  I  do  not  know  that  I  have  any  objections  to  make  to  the  plan  outlined, 
excepting  in  paragraph  eight,  where  the  statement  is  made  that  the  Board  of  Trustees 
reserves  the  power  to  discontinue  the  service  of  any  medical  officer.  Without 
making  any  modification  of  that  phrase  should  there  not  be  inserted  the  phrase  "for 
cause"?  Would  it  not  be  unfair  to  permit  the  Board  of  Trustees  full  power  to 
remove  an  attendant  without  cause?     Would  not  that  power  be  abused  at  times? 

Dr.  Alexander  McPhedran 
Toronto 

1.  A  paid  Service  should  be  very  much  more  efficient  than  a  voluntary  one,  since 
it  would  require  a  higher  degree  of  eificiency  and  a  closer  attention  than  you  can 
usually  get  from  voluntary  service.  I  fear,  however,  that  the  salary  suggested  is 
not  enough  to  secure  the  strongest  men  available.  But  it  is  a  striking  advance  on 
the  past  that  you  should  contemplate  undertaking   such   an  improved  organization. 

2.  The  plan  you  suggest  seems  to  provide  an  acceptable  means  of  securing  a  paid 
service  of  the  character  you  contemplate. 

3.  The  proportions  of  salaries  of  Chiefs  seem  fairly  divided  between  the  col- 
leges and  the  City. 

4.  I  am  somewhat  diffident  in  offering  the  objections  that  occur  to  me  and  I  hope 
you  will  receive  them  in  the  spirit  in  which  they  are  offered — a  desire  to  promote 
medical  science.  The  chief  objection  I  see  to  it  is  the  division  of  the  Hospital  into 
so  many  sections,  making,  in  fact,  four  independent  hospitals  so  far  as  the  staff  is 
concerned.  If  you  could  manage  to  consolidate  the  whole  into  one  under  the  direction 
of  one  of  your  colleges  you  should  secure  a  very  much  better  result.  You  have 
plenty  of  hospitals  in  New  York  to  place  at  the  disposal  of  each  university  a  large 
hospital  for  its  own  clinical  purposes.  It  is  a  well  known  fact  that  the  teaching  hospi- 
tal is  much  the  more  efficient  one.  It  is  probably  well  within  the  mark  to  say  that  no 
hospital  which  does  not  afford  teaching  facilities  is  of  the  highest  standard.  Why 
should  not  then  a  conference  be  held  between  the  various  universities  and  the  chief 
hospitals  to  arrange  for  placing  one  of  the  large  hospitals  at  the  disposal  of  each 
university?  It  is  only  in  this  way  that  you  can  get  the  best  care  of  the  patient  and 
at  the  same  time  promote  the  scientific  advance  of  medicine.  New  York  owes  it  to 
itself  and  to  the  country  to  make  it  one  of  the  centers  in  the  world  of  scientific 
medical  education.  It  now  has  probably  the  best  research  institute  in  the  world 
and  why  should  it  not  also  have  the  best  training  institutions  for  undergraduates  in 
medicine?  There  should  not  be  an  insuperable  difficulty  to  consummating  such  an 
arrangement.  Under  such  an  arrangement  the  head  of  the  department  of  medicine 
and  that  of  surgery  should  devote  nearly  the  whole  of  his  time  to  the  Hospital  inter- 
ests, not  allowing  probably  more  than  an  hour  or  two  a  day  for  private  consultations. 
They  should  be  aided  by  a  vigorous,  well-trained  staff  of  young  men  who  will  devote 
their  whole  time  to  the  Hospital  and  research  work  under  the  Chief's  direction.  No 
doubt  the  Chief  would  need  one  or  more  senior  men  as  assistants  who  would  give 
nearly  their  whole  time  to  the  Hospital.  To  my  mind  this  is  the  plan  that  offers 
the  best  results  for  the  Hospital  and  those  who  are  treated  in  it,  as  well  as  for  the 
education  of  the  undergraduate,  and  also  the  promotion  of  research  investigation. 

I  would  suggest  that  in  paragraph  three  of  your  draft  the  Advisory  Committee 
should  be  given  more  power.  Removals  and  appointments  should  only  be  on  their 
recommendation.  If  the  Trustees  do  not  approve  the  recommendation  they  should 
return  it  with  a  request  for  further  consideration.  The  Advisory  Committee  is  in 
the  best  position  to  understand  the  requirements  of  the  Hospital. 

4.  Should  not  the  out-patient  clinic  be  organized  as  separate  units  for  medicine  and 
for  surgery  with  directors  coordinate  with  the  Chiefs  of  the  indoor  services  in  charge? 

5.  Why  make  an  age  limit?  Some  men  are  more  efficient  at  seventy  than  otliers 
are  at  fifty.  Why  should  not  efficiency  be  the  limit?  It  is  so  in  Germany,  a  country 
in  which  perhaps  the  most  advanced  work  so  far  is  being  done. 

7.  As  examination  is  a  poor  standard  to  judge  qualification,  would  it  not  be  better 
to  accept  the  recommendations  from  the  heads  of  institutions  from  whom  you  would 
be  willing  to  accept  candidates  for  the  indoor  staff,  the  recommendations  to  state  not 
only  the  academic  qualifications  but  also  personal  fitness?  The  institutions  so  favored 
would  recognize  the  necessity  of  recommending  only  capable  men;  that,  I  think, 
would  be  sufficient  in  securing  an  efficient  indoor  staff,  and,  in  that  way,  safer  than 
you  would  be  by  examination. 


REORGANIZATION   OP  MEDICAL   SERVICE  745 

9.  Each  service,  I  presume,  will  have  its  own  clinical  laboratory.  Should  not  that 
laboratory  be  under  direction  of  the  head  of  the  service  and  not  under  the  Pathological 
Department,  although  the  cooperation  of  the  Pathological  Department  should  be 
secured?  If  the  Director  of  Laboratories  is  only  a  hospital  officer  is  it  certain  that 
there  would  be  cooperation  between  him  and  the  college  pathologists  whose  work  the 
Director  is  to  supervise?  I  suppose  the  college  pathologist  will  be  a  resident  in  the 
Hospital. 

Dr.  Rufus  Cole,  Director 

The  Hospital  of  the   Rockefeller  Institute  for  Medical  Research 

New  York 

I  take  pleasure  in  replying  to  your  letter  of  December  l6th  requesting  my  opinion 
of  the  suggested  plans  for  reorganization  of  the  medical  service  of  Bellevue  Hospital. 
I  do  this  with  the  understanding,  stated  in  your  letter,  that  my  views  have  a  general 
application  and  do  not  necessarily  apply  especially  to  the  medical  service  at  Bellevue, 
since  I  have  too  slight  familiarity  with  conditions  there  to  justify  my  making  any 
specific  recommendations.  The  suggestions  I  have  to  make  apply  especially  to  the 
medical  service,  since  I  have  had  no  experience  in  the  organization  of  a  surgical 
clinic. 

The  plan  as  outlined  by  you  seems  to  me  to  mark  a  very  distinct  and  important 
advance  in  the  present  methods  of  organization  of  the  medical  service  of  general 
hospitals.  The  hospital  can  only  demand  efficient  service  from  its  attending  staff  when 
it  gives  something  in  return  for  service  rendered.  It  is  too  much  to  expect  that  such 
a  large  part  of  the  time  of  physicians  as  is  required  for  efficient  hospital  service  should 
be  given  from  purely  altruistic  motives,  a  very  much  larger  sacrifice  for  social 
service  than  is  demanded  from,  or  given  by,  men  of  any  other  profession  or  occupa- 
tion. As  a  matter  of  fact,  this  service  in  the  past  has  not  been  rendered  purely  for 
this  reason,  but  has  been  given  because  recompense  is  obtained  by  the  physician  for 
the  time  spent:  (i)  through  increased  experience  gained  and  so  increased  ability  and 
power,  and  (2)  through  increased  prestige  gained  both  with  the  profession  and  the 
public.  The  first  recompense  is  certainly  legitimate  and  the  desire  for  it  praiseworthy ; 
the  second  occupies  a  distinctly  lower  plane  and,  when  allowed  to  become  the  main 
recompense  for  the  service  rendered,  has  led  to  the  great  abuses  with  which  all  are 
familiar.     It  should  be  entirely  disregarded  by  both  the  hospital  and  the  physician. 

The  organization  and  direction  of  a  medical  clinic  require  a  very  large  amount 
of  time,  and  it  is  doubtful  whether  a  physician,  depending  for  his  income  upon  his 
practice,  without  any  other  financial  recompense,  could  afford  to  devote  to  it  sufficient 
time  to  obtain  satisfactory  results.  Your  plan  provides  that  such  work  will  require 
at  least  four  hours  per  day.  I  should  say  that  this  is  a  low  rather  than  a  high 
estimate  of  the  time  required.  The  salary  of  $5,000  provided  for  the  Chief  of  clinic 
should  enable  a  man  of  the  very  best  training  and  ability  to  give  at  least  half  his  time 
to  this  work.  The  added  recompense  in  the  way  of  increased  skill  and  knowledge 
would  undoubtedly,  with  the  fees  at  present  obtained  for  the  best  service,  enable 
such  a  man  to  make  an  income  commensurate  with  that  obtained  by  the  best  men  in 
the  other  professions. 

The  provision  made  for  a  Resident  Physician  to  give  all  his  time  and  to  act  as 
assistant  to  the  Chief  of  the  clmic  will  enable  the  latter  to  most  effectively  employ  the 
time  at  his  disposal.  The  provision  to  pay  the  Resident  Physician  a  small  salary  seems 
to  me  wise  and  just.  With  a  Chief  of  clinic  giving  half  his  time,  a  Resident  Physician 
of  considerable  experience  giving  his  full  time,  and  a  stafif  of  capable  assistant  attend- 
ing physicians  and  of  capable  internes,  a  good  clinic  could  be  rather  efficiently  manned. 

The  attending  physicians,  under  the  plan  proposed,  are  to  receive  no  salaries.  If 
they  give  only  one  or  two  hours  a  day  to  the  work,  it  would  seem  that  the  recompense 
in  the  way  of  increased  skill  and  knowledge  would  be  quite  sufficient,  and  that  their 
incomes,  instead  of  suffering  from  such  time  given,  would  be  increased.  It  is  under- 
stood, of  course,  that  the  attending  physicians  will  have  continuous  service. 

At  present  certainly  a  sufficient  number  of  physicians  can  be  obtained  to  act  as 
Chiefs  of  the  various  clinics,  who  are  trained,  not  only  in  methods  of  physical  diagnosis, 
but  in  the  other  more  fundamental  methods  of  clinical  study  as  well,  and  who  are 
able  to  act  as  directors  of  such  clinical  laboratories  as  well  as  have  supervision  of 
the  nursing  and  immediate  care  of  the  patients.  If  such  men  cannot  be  obtained, 
there  is  something  radically  wrong  with  medical  training  in  the  past.  Twenty  years 
ago  such  men  were  not  available  in  this  country,  but  if  the  Hospital  will  provide 
opportunities  such  as  mentioned  there  will  be  little  difficulty  in  obtaining  a  proper 
Chief  for  each  of  the  medical  clinics.    Without  such  provision,  however,  it  is  hardly 


746  HOSPITAL   COMMITTEE 

likely  that  it  will  be  possible  to  obtain  the  services  of  the  kind  of  men  needed,  and 
the  Hospital  will  gain  very  little  from  the  change  of  plan.  If  the  proposed  Chief  of 
clinic  is  simply  going  to  devote  a  few  more  hours  a  day  than  is  now  given  to  physical 
diagnosis,  very  little  will  have  been  gained  by  the  proposed  change,  except  the  endow- 
ment of  a  series  of  men  with  $s,ooo  a  year  each. 

As  to  the  proportional  part  of  salaries  which  the  Hospital  and  medical  schools 
should  pay,  it  seems  that  the  provisions  of  the  plan  are  equitable  and  just.  If  the 
Hospital  is  willing  to  accept  the  recommendation  of  the  medical  schools  regarding 
appointments  in  the  clinics  in  which  teaching  is  done,  the  schools  should  consider 
themselves  fortunate  that  the  Hospital  is  willing  to  pay  half. 

At  the  present  time  it  may  be  impossible  to  give  the  so-called  Advisory  Committee 
powers  other  than  advisory.  When  the  ideal  medical  staff  is  obtained,  however,  I 
feel  that  in  the  ideal  hospital  this  board  will  have  large  powers  as  regards  all  the 
details  of  hospital  management.  This  may  not  be,  however,  until  instead  of  half  time 
chiefs  of  clinics    there  will  be  full  time  chiefs. 

Dr.  F.  a.  WashburNj  Administrator 

Massachusetts  General   Hospital 

Boston 

I  enclose  a  reprint  which  gives  my  views  on  the  subjects  in  question  better  than  I 
can  do  it  in  a  letter. 

In  your  paragraph  2,  under  the  duties  of  the  Superintendent  I  should  add  the 
control  of  the  training  school  for  nurses.  I  should,  however,  have  an  advisory  board 
of  ladies  and  gentlemen  interested  in  nursing  so  that  the  general  policy  of  the  school 
may  be  broad  and  not  narrowed  by  the  individual  views  of  a  given  superintendent. 

Under  paragraph  3  I  should  go  a  step  further  and  do,  as  we  have  done  in  this  Hos- 
pital, delegate  to  this  board  authoritative  control  of  the  medical  and  surgical  affairs 
of  the  Hospital,  but  when  it  comes  to  the  question  of  administration  or  the  spending 
of  money  I  should  make  that  function  advisory  only. 

I  should  make  this  "Advisory  Committee,"  as  you  call  it,  the  nominating  body  for 
all  staff  appointments. 

I  am  sending  you  a  copy  of  our  rules  and  regulations.  Our  Executive  Committee 
corresponds  to  your  "Advisory  Committee."  It  is  essential  that  the  superintendent 
should  be  the  secretary  of  this  committee. 

I  think  that  the  paid  Chief  should  be  nominated  and  appointed  by  the  Hospital  and 
not  by  the  medical  school.  Nomination,  however,  should  be  made  after  consultation 
with  the  medical  school  and,  if  possible,  an  agreement  with  them.  The  functions  of  a 
large  general  hospital  are  to-day  too  complex  and  too  important  to  the  community 
for  us  to  allow  the  single  function  of  medical  education  to  be  the  only  one  con- 
sidered. A  man  may  be  an  excellent  professor  of  medicine  and  not  have  any  adequate 
conception  of  the  duty  of  the  hospital  to  prevent  and  cure  industrial  and  social 
disease.  He  may  not  be  willing  to  use  the  social  service  as  it  can  be  used  to  the 
great  advantage  of  a  hospital.  In  other  words,  the  hospital  must  see  to  it  that  the 
chiefs  of  service  are  broad  men  and  capable  of  looking  out  for  all  the  functions  of  the 
hospital.  The  medical  school  has  only  one  thing  in  mind,  that  is,  teaching.  If_  a  man 
combines  the  qualifications  which  the  hospital  needs  and  the  qualities  which  the 
school  needs,  so  much  the  better.  If  he  has  not  the  qualities  which  the  hospital  needs 
I  would  put  him  under  the  chief  of  service,  but  let  the  executive  committee  see  to  it 
that  he  has  the  necessary  teaching  material.  It  is  not  essential  that  the  professor 
of  the  medical  school  should  be  chief  of  hospital  service.  The  teaching  material  can 
be  given  him  without  his  holding  that  position. 

I  believe  it  is  wise  to  pay  a  Chief  and  to  have  the  Hospital  pay  its  share. 

Dr.  George  Dock 
St.  Louis 

I  shall  discuss  the  Tentative  Outline  by  numbers. 

1.  Very  good. 

2.  Very  good. 

3.  Very  good. 

4.  Very  good. 

5.  I  think  a  paid  service  is  the  only  way  in  which  to  get  the  work  necessary  in 
medicine  at  the  present  time,  and  the  payment  should  be  in  proportion  to  the  quality 


REORGANIZATION   OF  MEDICAL   SERVICE  747 

of  service  rendered  and  the  time  devoted  to  the  work.  As  the  head  should  have  the 
chief  responsibihty  and  should  be  doing  actual  work  teaching  undergraduates,  training 
the  staff,  guiding  investigations,  and  himself  investigating,  enough  should  be  paid  to 
make  it  possible  to  secure  the  services  of  a  thoroughly  satisfactory  man.  The  salary 
suggested,  $S,ooo  a  year,  suggests  that  the  head  must  add  to  his  income  by  some 
other  activity,  such  as  private  practice.  This  will,  probably,  always  be  possible. 
On  the  other  hand,  unless  the  medical  school  would  materially  increase  its  share  of 
the  income,  the  Hospital  might  lose  the  services  of  men  who  would  not  care  to  prac- 
tice. Four  hours  a  day,  for  example,  is  not  enough  for  the  activity  I  have  mentioned, 
although  I  should  say  it  is  enough  for  the  suggested  salary  of  $S,ooo.  An  age  for 
retirement  is  proper,  but  should  not  be  based,  in  the  case  of  medicine,  on  the  same 
grounds  that  apply  in  the  navy  and  army,  and  perhaps  in  surgery. 

The  attending  physicians  and  surgeons,  I  assume,  are  not  to  be  paid.  If  this  is  so, 
the  conditions  under  which  they  hold  their  service  should  be  very  carefully  arranged; 
such  free  services  may  be  very  valuable,  but  justice  to  both  the  attendants  and  the  hos- 
pital must  be  assured.  The  rest  of  the  details  in  number  s  are  good. 

6.  Good,  provided  incumbents  have  proper  experience  and  qualifications. 

7.  Good,  provided  personal  element  is  considered  in  addition  to  the  result  of  a 
technical  or  professional  examination. 

8.  Power  to  discontinue  service  should  be  based  on  cause,  with  the  right  of  investi- 
gation if  desired  by  the  individual  concerned. 

9.  The  scheme  proposed  should  be  very  satisfactory,  but  would  have  to  be  care- 
fully worked  out.  It  would  be  essential  that  all  heads  of  clinical  departments  be 
able  to  keep  in  close  touch  with  the  Pathological  Department  and  that  the  methods 
followed  by  the  Pathological  Department  be  satisfactory  to  the  clinical  Chiefs. 

In  answer  to  number  2  of  your  letter,  I  do  not  think  the  plan  provides  a  large 
enough  staff  of  paid  men.  There  should  be  some  men  beyond  the  rank  and  experi- 
ence of  internes  and  subordinate  to  the  residents.  There  should  also  be  full  time  men 
of  experience  doing  special  clinical  work  in  bacteriological,  chemical,  and  physiological 
sides.  Such  men  should  have  positions  of  about  the  rank  of  resident  and  the  salary 
should  be  commensurate  with  their  value;  say,  from  $1,500  to  $3,000  a  year. 

3.  Both  the  City  and  the  colleges  would  seem  to  be  getting  a  great  deal  for  their 
money  if  we  believe  the  heads  are  to  devote  themselves  chiefly  to  their  work  and  not 
use  the  positions  for  aid  in  private  practice.  As,  however,  the  positions  are  in  the 
public  service,  which  would  appeal  to  some  men,  the  salaries  may  not  be  too  small. 
I  am  not  sure  whether  they  are  as  large  as  those  paid  in  other  municipal  departments 
of  the  same  importance. 

4.  I  find  no  serious  objections  to  the  plan,  but  think  it  would  be  a  good  one,  and 
that  some  of  the  details,  such  as  size  of  staff  and  the  salaries  for  all  ranks,  would 
have  to  be  based  on  the  possibility  of  getting  the  best  men  for  the  places. 

Dr.  Alfred  Stengel 
Philadelphia 

In  answer  to  your  letter  of  December  isth  regarding  the  proposed  plan  for 
government  and  administrative  organization  of  Bellevue  Hospital,  I  subdivide  my 
remarks  a  little  differently  from  the  order  of  your  questions. 

I.  The  general  plan  seems  to  me  well  adapted  to  secure  for  Bellevue  Hospital 
the  kind  of  services  that  modern  conditions  demand.  The  casual  and  irregular 
attendance  of  physicians  and  surgeons  so  customary  in  American  hospitals  up  to  the 
present  day  should  be  done  away  with,  and  the  principal  features  of  your  plan — viz.,  to 
have  continuous  service  and  to  exact  half  day  work — should  be  introduced  everywhere. 
It  is  obvious  that  such  exactions  will  restrict  the  occupancy  of  hospital  positions  to 
a  certain  type  of  men — those  who  are  interested  in  more  than  merely  perfunctory  care 
of  patients  and  whose  private  work  is  limited  to  consultation  practice.  When  such 
an  arrangement  is  effected  our  hospitals  will  be  in  practically  the  same  position  as  those 
of  Europe,  especially  the  Continental  ones.  The  headship  of  a  hospital  service  under 
these  circumstances  carries  with  it  a  special  sort  of  dignity  and  establishes  the  in- 
cumbent as  a  consulting  physician  or  surgeon  of  high  rank.  In  short,  it  establishes  a 
special  class  separate  from  family  practitioners,  and  by  reason  of  its  exactions  would 
reserve  such  positions  for  men  whose  interests  are  centered  about  teaching,  investiga- 
tion, and  whatever  pertains  to  advance  in  medical  science.  It  seems  too  obvious  to 
require  much  discussion  that  the  facilities  of  well  equipped  hospitals  should  not  be 


748  HOSPITAL  COMMITTEE 

at  the  disposal  of  those  who  give  many  hours  daily  and  their  best  efforts  to  general 
practice  and  only  perfunctory  service  to  the  hospital  with  which  they  may  be  asso- 
ciated. 

2.  The  question  of  voluntary  versus  paid  service  cannot  be  answered  without 
reference  to  local  conditions  and  present  day  customs.  If  the  European  system  were 
now  in  vogue  and  if  the  holding  of  hospital  chiefships  gave  men  here  the  distinction 
among  the  laity  as  well  as  the  medical  profession  customary  in  Europe,  little  discus- 
sion of  the  matter  of  salary  would  be  necessary.  A  half  day  free  for  consultation 
work  would  be  ample  for  individuals  in  this  fortunate  situation  to  earn  enough  to  be 
satisfactory  to  the  desirable  type  of  men.  Unfortunately,  up  to  the  present  time,  such 
hospital  positions  even  in  the  best  hospitals  of  New  York  and  other  large  cities  have 
been  mere  incidents  in  a  general  family  practitioner's  daily  work.  Should  one  hospital 
like  Bellevue  change  the  system  and  make  special  exactions  upon  its  Chiefs  while  other 
hospitals  continued  in  the  old  way  a  great  hardship  would  be  imposed  upon  the  newly 
made  Chiefs  thus  restricted.  Later,  doubtless,  as  other  hospitals  adopted  the  same  plan 
the  difficulty  would  grow  less.  Under  the  circumstances,  it  seems  to  me  that  the 
introduction  of  the  new  system  ought  to  carry  with  it  a  provision  of  salaries  to  those 
who  will  be  asked  to  give  up  so  much  of  their  time.  Whether  these  salaries  shall  be 
provided  by  the  hospitals  or  by  the  medical  schools  or  both  is  a  matter  partly  to  be 
decided  by  the  kind  of  hospital  involved.  In  the  beginning,  undoubtedly,  the  interests 
of  both  the  Hospital  and  the  medical  school  will  be  best  served  by  a  combination. 
Later,  it  seems  to  me,  the  Hospital  should  be  absolved  from  any  payment  of  salary. 
In  giving  facilities  for  study  and  a  position  of  distinction,  plus  the  opportunity  which 
should  be  free  and  ample,  to  teach  students,  the  Hospital  will  pay  its  share.  In 
paying  a  salary  sufficient  to  hold  the  best  type  of  men  to  this  kind  of  work  in  return 
for  their  teaching  of  students,  the  medical  school  would  be  paying  its  share.  The 
final  ideal,  then,  would  seem  to  me  to  be  the  requirement  as  to  time  of  service  which 
you  specify,  the  granting  of  abundant  facilities,  and  the  right  to  teach  on  the  part 
of  the  Hospital,  and  of  an  adequate  though  moderate  recompense  in  return  for  a 
reasonable  amount  of  teaching  on  the  part  of  the  medical  school.  The  immediate 
introduction  of  this  plan  in  toto  would,  I  fear,  deprive  the  Hospital  of  some  of  the 
most  desirable  men  who  would  be  compelled  to  seek  elsewhere  for  opportunity  upon 
easier  terms.  A  salary,  such  as  you  contemplate — made  up  by  equal  sums  from  the 
Hospital  and  medical  school — would  avoid  this  difficulty,  while  at  the  same  time  it 
would  prevent  political  maneuvering  for  the  positions,  which  would  be  almost  certain 
to  happen  if  the  Hospital  paid  the  salaries  wholly. 

3.  It  seems  to  me  your  Committee  has  decided  upon  the  best  plan  for  securing 
the  kind  of  service  modern  requirements  demand.  The  alternative,  or  requiring 
full  time  service,  would  involve  the  selection  of  an  entirely  different  type  of  men.  A 
half  day's  work  is  as  much  as  most  men's  strength  will  permit  them  to  give  to  steady 
hospital  service.  The  rest  of  the  day  would  either  be  wasted  or  devoted  to  study  and 
investigation  probably  in  laboratories.  The  former  contingency  would  be  unfortunate ; 
the  latter  would  be  satisfactory  in  the  case  of  a  few  men,  but  would  be  undesirable  if 
required  of  all.  The  better  plan,  therefore,  to  secure  good  clinical  men — medical  or 
surgical — seems  to  me  the  one  you  have  adopted  of  requiring  a  half  day's  work  and 
leaving  the  chief  free  to  do  consultation  practice  during  the  rest  of  the  day. 

Dr.  David  L.  Edsall 
Boston 

1.  I  do  believe  that  a  paid  service  is  preferable  to  a  voluntary  service  because  I  be- 
lieve that  hospitals,  if  well  run,  must  have  more  time  from  their  staffs,  particularly 
certain  members  of  their  staffs,  than  is  possible  for  men  to  give  if  they  get  no  remuner- 
ation for  it. 

2.  I  think  the  plan  you  submit  provides  a  satisfactory  means  of  securing  a  paid 
service.  The  only  comment  upon  this  point  that  I  would  make  would  be  that  you  say 
the  City  should  pay  one-half  the  salary,  but  such  half  shall  not  exceed  $2,500  per 
year.  It  might  be  impossible  to  get  enough  of  a  man's  time  for  $S,ooo  a  year  and 
it  would  seem  to  me  to  be  better  to  say  that  the  City  pay  part  of  the  salary  but  that 
that  part  shall  not  exceed  $2,500,  if  it  be  necessary  to  limit  the  City's  share  to  that 
amount. 

3.  I  have  indicated  an  answer  to  this  in  the  last  question.  I  think,  however,  it 
is  fairer  that  the  medical  school  and  the  hospital  should  equally  share  in  the  salaries 
paid,  and  it  is  best  for  the  relations  of  the  individuals  to  both  the  medical  school  and 
the  hospital  that  they   should  feel  an  equal   responsibility   toward  both  and  should 


REORGANIZATION   OP  MEDICAL   SERVICE  749 

not,  as  has  been  too  much  the  case  in  the  past,  feel  that  their  serious  responsibilities 
are  chiefly  with  the  medical  school  and  that  the  hospital  has  to  take  the  leavings  if 
they  get  pushed.  I  think  that  the  relations  all  around  would  be  better  if  the  men 
all  felt  both  directly  and  indirectly  they  were  equally  responsible  to  the  hospital  and 
the  school  and  financially  as  well  as  otherwise  equally  in  tlie  control  of  each  institu- 
tion. If  in  any  way  heretofore  the  service  to  hospitals  has  not  been  as  good  as  it 
should  have  been,  I  think  it  is  perfectly  fair  to  say  that  that  is  because  it  has  been 
impossible  for  a  large  proportion  of  medical  men  to  give  any  better  service,  and  the 
hospital  has  not  provided  them  with  the  opportunity  for  giving  better  service.  On 
the  other  hand,  if  the  hospital  does  provide  them  better  facilities  and  pay  them,  I 
think  they  can  hold  them  clearly  responsible  for  whatever  duties  are  assigned  to 
them. 

I  think  the  plan  that  you  send  is,  in  its  general  features,  an  excellent  one.  It  is 
not  dissimilar  to  the  one  now  in  use  in  the  Massachusetts  General  Hospital,  and 
which  seems  to  be  working  very  well  here.  The  only  point  that  I  would  seriously  criti- 
cise being  that  I  think  the  proposed  advisory  medical  board  ought  to  have  rather 
more  than  simply  advisory  powers.  That  is,  I  would  not  consider  giving  them  power 
in  any  way  over  the  finances  of  the  Hospital  or  over  purely  administrative  problems, 
nor  would  I  give  them  final  power  regarding  anything  excepting  certain  internal 
matters  which  can  quite  properly  be  determined  by  such  advisory  board,  but  I  do  think 
if  you  get  a  group  of  first  rate  men  together  you  cannot  long  keep  them  interested 
and  active  or  very  devoted  to  work  that  limits  them  absolutely  to  purely  advisory 
things,  especially  if  they  grew  to  feel  that  their  advice  was  very  frequently  not  being 
followed. 

I  think  it  very  desirable  that  all  nominations  for  staff  positions  should  come 
through  the  proposed  advisory  board,  and  through  no  other  source,  unless,  in  indi- 
vidual cases,  it  became  impossible  for  the  Trustees  and  such  advisory  board  to  agree, 
in  which  case  the  Trustees  would  of  course  have  to  exercise  final  power.  I  think  a 
great  many  administrative  details  which  relate  really  to  the  work  of  the  chiefs  of 
service  and  their  assistants  ought  to  be  determined  by  an  advisory  board  rather  than 
by  the  purely  administrative  officers.  That  we  find  perfectly  feasible,  and  indeed  far 
more  effectual,  at  Massachusetts  General  Hospital  than  the  other  method  of  running 
things. 

Dr.  Richard  C.  Cabot 
Boston 
In  answer  to  your  questions,  I  would  say: — 

1.  I  consider  paid  service  preferable  to  voluntary  service,  because  a  hospital  can 
control  and  criticise  the  work  of  its  paid  employees  far  more  satisfactorily  and 
because  the  plan  seems  to  have  worked  well  in  other  hospitals. 

2.  I  think  your  plan  of  starting  with  paid  Chiefs  of  Service  is  the  best  one,  as  an 
entering  wedge.  Ultimately  I  think  all  physicians  connected  with  hospitals  will 
have  to  be  paid,  but  not  at  present. 

3.  I  think  the  proportion  of  salaries,  as  divided  between  the  Hospital  and  the  City, 
is  fair. 

I  know  nothing,  of  course,  about  the  special  provision  for  the  "Fourth  Division" 
but  I  see  no  objection  to  the  plan,  as  outlined,  so  far  as  I  understand  it.  In  essentials, 
it  is  the  plan  under  which  we  are  now  operating  at  Massachusetts  General  Hospital, 
though  we  have  not  as  yet  voted  to  pay  our  Chiefs  of  Service. 

Dr.  George  W.  Crile 
Cleveland 

I  have  read  with  much  interest  your  communication  of  December  isth,  regarding 
the  proposed  plan  for  the  organization  of  the  Bellevue  Hospital. 

On  the  whole,  the  scheme  as  outlined  should  prove  workable  and  advantageous. 
I  would  only  suggest  that  to  my  mind  the  various  Services  should  be  organized  on  a 
strictly  military  system,  so  that  a  single  individual  in  each  Service  has  the  undivided 
responsibility  for  that  Service  and  controls  a  series  of  residents  of  different  grades 
of  rank,  who  receive  varying  remuneration.  These  assistants  or  residents  should  be 
promoted  by  seniority  or  fitness,  or  should  be  discharged  on  the  recommendation  of 
the  Chief  of  the  Service. 


7SO  HOSPITAL    COMMITTEE 

Dr.  Winford  Smith 

The  Johns  Hopkins  Hospital 

Baltimore 

1.  I  consider  a  paid  service  preferable  to  a  voluntary  service.  It  enables  the  physi- 
cian to  spare  more  of  his  time  and  it  enables  the  hospital  to  demand  more  of  his 
time. 

2.  I  believe  the  plan  does  provide  an  acceptable  means  of  procuring  a  paid  service. 

3.  I  think  the  proportions  of  salaries  as  arranged  are  probably  a  fair  adjustment, 
inasmuch  as  it  is  customary  for  the  medical  colleges  to  pay  some  salary  to  their  pro- 
fessors, and  presumably  the  Chiefs  of  these  clinics  will  be  the  professors  of  the  medical 
schools.  Strictly  speaking,  of  course,  the  City  should  pay  the  entire  salary  for  the 
service  rendered  to  its  patients,  if  we  are  to  accept  the  system  of  a  paid  service,  and 
I  believe  we  shall  have  to  accept  it  as  desirable. 

4.  Of  course  the  first  objection  that  will  be  made  is  that  men  with  large  reputa- 
tions cannot  afford  to  give  half  of  their  time  to  the  Hospital  for  the  small  salary 
provided.  The  answer  to  that  is  obvious.  It  is  doubtful  whether  or  not  a  hospital 
can  afford  to  place  its  patients  in  the  hands  of  a  man  who  can  give  so  little  of  his 
time  to  a  hospital.  It  is  my  personal  opinion  that  there  are  earnest,  ambitious,  and 
scientific  men,  possibly  at  the  present  time  of  a  lesser  reputation  and  possibly 
of  a  younger  generation,  but  men  who  would  be  eminently  satisfactory  from  a  pro- 
fessional point  of  view,  who  could  be  easily  found  for  such  service.  Furthermore,  I 
feel  very  strongly  that  such  a  man,  giving  sufficient  time  to  the  work  to  be  thoroughly 
in  touch  with  his  cases  and  to  have  full  knowledge  of  all  that  is  going  on  in  his 
service,  even  though  he  be  of  lesser  reputation,  is  a  much  more  valuable  man  to  a 
hospital  than  a  man  of  large  reputation  who  gives  so  little  time  to  the  service  as  to 
have   only   a    most   superficial   knowledge    of    the   cases    under    his    charge. 

5.  In  paragraph  S  of  the  plan  outlined,  I  think  it  undesirable  to  assume  at  the 
start  that  men  of  the  caliber  it  is  hoped  will  be  provided  by  this  system  are  not 
going  to  perform  their  duties  in  good  faith,  which  assumption  is  apparently  mani- 
fested by  the  attempt  to  limit  these  professional  men  strictly  to  certain  hours.  Pro- 
fessional men  resent  this.  I  think  the  statement  that  they  are  to  give  one-half  their 
time  to  the  Hospital  is  sufficient;  but  to  say  one-half  of  each  day  and  to  make  it 
necessary  for  them  to  put  in  four  consecutive  hours  is  unnecessary  and  objectionable. 

Nominations  should  be  made  by  the  Chiefs  to  the  i\ledical  Board  or  the  .A.dvisory 
Committee,  whatever  it  is  called,  and  by  the  Committee  to  the  Board  of  Trustees. 
The  Trustees  should  not  act  on  any  nomination  unless  approved  by  the  Medical 
Board.  I  think  it  would  be  wrong  for  the  heads  of  the  Fourth  Division  to  be  nomi- 
nated by  the  Council  of  the  Academy  of  Medicine.  I  cannot  see  that  the  Academy 
of  Medicine  has  anything  to  do  with  the  matter,  and  not  even  the  New  York  Academy 
of  Medicine  can  guarantee  that  its  members  will  not  play  medical  politics  with  refer- 
ence to  such  appointments ;  and  medical  politics  as  related  to  public  institutions  can  be 
just  as  bad  as  any  other  kind  of  politics. 

6.  The  resident  physicians  and  surgeons  should  be  paid  entirely  by  the  City. 
They  are  hospital  appointments,  strictly  speaking,  not  university  appointments. 

Dr.  Theodore  C.  Janeway 
New   York 

The  placing  of  hospital  services  under  single  and  responsible  heads,  medical  and 
surgical,  has  been  so  long  in  operation  in  all  foreign  countries  and  with  such  entire 
success  both  from  the  standpoint  of  hospital  administration  and  of  university  instruc- 
tion in  medicine,  that  there  should  be  little  need  of  argument  for  its  adoption  here. 
The  main  obstacle  has  always  been  that  the  time  required  of  such  heads  for  effective 
supervision  is  so  great  as  to  be  impracticable  under  our  system  of  voluntary  service 
of  physicians  and  surgeons.  Men  serving  without  pay  can  naturally  give  a  much 
smaller  portion  of  their  time,  and  it  has  been  convenient  for  them  to  give  this  for 
only  a  portion  of  the  year.  Hence  our  rotating  services.  With  the  introduction  of  a 
paid  service,  such  as  exists  in  Germany,  the  single  headed  organization  becomes  at 
once  practicable,  and  for  this  reason  I  am  a  thorough  believer  in  it.  In  addition,  the 
receipt  of  the  salary  from  the  City  makes  for  strict  accountability  for  the  performance 
of  their  duties  by  the  salaried  appointees.  I  believe  that  your  plan — under  the  peculiar 
conditions  existing  in  Bellevue  Hospital  of  Divisions,  three  of  them  already  afliliated 
with  medical  schools — provides  a  thoroughly  acceptable  means  of  securing  a  salaried 


REORGANIZATION   OF  MEDICAL   SERVICE  751 

staff  of  the  highest  order  of  professional  ability.  Your  division  of  the  expense  be- 
tween the  City  and  the  medical  colleges  seems  to  me  just  to  both  parties,  and  to 
represent  as  nearly  as  can  be  estimated  the  amount  of  time  which  the  physicians  and 
surgeons  will  give  respectively  to  the  conduct  of  their  services  and  to  teaching.  I  can 
find  no  serious  objections  to  the  plan  as  outlined. 

Under  existing  conditions  it  would  be  possible  to  debate  profitably  the  disad- 
vantages of  the  present  arrangement  of  Divisions,  particularly  as  it  affects  cooperation 
with  the  Pathological  Department,  but  I  believe  that  no  proposal  to  change  the  existing 
Divisions  could  meet  with  acceptance  at  present.  Therefore,  I  feel  that,  without 
making  any  changes  in  the  framework  of  the  Hospital  organization,  you  have  provided 
a  scheme  which  both  for  the  Medical  and  Surgical  Services  and  for  the  Pathological 
Department  should  result  in  much  more  effective  service  to  the  City  and  much  more 
thorough  utilization  of  the  vast  facilities  of  Bellevue  Hospital  for  medical  instruction 
and  investigation. 

Dr.  George  Blumer 

Dean  of  the  Medical  Faculty 

Yale  University 

New  Haven 

I  am  in  receipt  of  your  letter  of  December  isth  and  am  answering  it  to  the 
best  of  my  ability.  In  judging  of  the  value  of  answers  on  the  main  question  you 
raise — namely,  paid  vs.  voluntary  service — I  think  that  you  should  take  into  account 
the  fact  that  paid  general  hospital  service  has  been  tried  in  the  United  States  in  very 
few  places  and  that  consequently  any  opinion  on  the  subject  must  be  either  based 
upon  rather  limited  observation  or  else  must  be  purely  academic.  My  personal  experi- 
ence with  paid  services  in  a  general  hospital  is  limited  to  what  I  observed  when  a 
house  officer  in  the  Johns  Hopkins   Hospital  some  twenty  years  ago. 

1.  I  do  consider  a  paid  service  preferable  to  a  voluntary  service.  From  what  I 
have  seen  of  voluntary  services  in  a  number  of  American  cities,  a  considerable  pro- 
portion of  them  are  inadequately  attended  to.  This  sometimes  results  from  the  fact 
that  the  attending  physician  feels  that  he  must  never  neglect  his  outside  practice,  which 
is  his  only  source  of  income;  and  it  sometimes  results  from  lack  of  conscience  on  the 
part  of  the  attending  physician  or  surgeon.  It  seems  pretty  obvious  to  me  that  the 
main  advantage  of  a  paid  service  is  that  the  employer  can  hold  the  employee  strictly 
responsible  for  a  stipulated  amount  of  his  time  and  any  neglect  on  the  part  of  the 
employee  can  be  very  promptly  checked. 

2.  In  a  general  way  the  plan  that  you  propose  seems  to  me  a  fair  and  equitable 
one,  although  there  are  some  things  that  I  should  have  a  little  doubt  about,  possibly 
because  I  do  not  understand  the  reasons  for  them.  Such,  for  example,  as  the  appoint- 
ment of   a   superintendent  for  a  prescribed  period  of   years. 

3.  I  consider  the  proportions  of  the  salaries  to  be  paid  by  the  medical  schools 
and  the  Hospital  as  entirely  fair.  This  is  the  proportion  that  is  paid  in  the  Brigham 
Hospital  in  Boston,  and,  I  think,  from  my  experience  in  teaching  work  in  hospitals, 
represents  fairly  the  proportion  of  work  given  to  teaching  as  compared  with  the 
proportion  given  to  the  actual  care  of  patients.  Of  course,  the  two  processes  are  so 
intimately  associated  that  they  cannot  be  sharply  separated. 

4.  The  only  objection  that  I  find  to  the  plan  is  the  amount  of  salary,  and  when 
I  say  I  object  to  this  I  do  so  only  in  a  modified  way.  I  think  that  the  salary  is 
sufficient  for  the  amount  of  time  demanded;  i.  e.,  half  a  day.  The  only  question  in 
my  mind  is  whether  by  doubling  the  salary  and  getting  the  medical  schools  also  to 
double  it,  and  insisting  that  the  appointee  devote  his  whole  time  to  hospital  work  and 
hospital  research,  you  would  not  get  better  results.  You  probably  know  that  this  is 
the  plan  that  the  Rockefeller  Foundation  is  trying  to  inaugurate  in  Baltimore.  It  is 
fair  to  say  that  it  is  purely  an  experimental  plan.  It  has  not  been  tried  out  anywhere, 
but  the  logic  on  which  it  is  based  is.  to  my  mind,  so  unassailable  that  it  seems  to  me 
the  plan  ought  to  be  thoroughly  tried  out.  It  is,  of  course,  highly  improbable  that 
you  could  get  the  present  Chiefs  of  the  three  medical  school  Divisions  to  accede  to 
such  a  plan,  as  they  are  doubtless  making  much  larger  incomes  than  ten  thousand 
dollars  a  year.  The  medical  schools,  however,  might  be  willing  to  accede  to  the  plan 
and  substitute  younger  men  with  different  ideals  for  the  present  Chiefs.  I  offer  this 
suggestion  to  you  for  consideration.  It  may  be,  in  the  opinion  of  j'our  Committee, 
entirely  impractical,  owing  to  local  circumstances.  On  the  other  hand,  it  might  appeal 
to  your  Committee  as  an  opportunity  to  place  Bellevue  Hospital — which  has  always 


752  HOSPITAL   COMMITTEE 

been  one  of  the  great  hospitals  of  the  United  States — in  the  position  of  one  of  the 
leaders  in  the  reform  of  our  hospital  system. 

I  am  in  receipt  of  your  letter  of  December  the  19th. 

I  thoroughly  agree  with  Dr.  Delafield's  view  that  as  a  rule  only  the  advanced 
stages  of  disease  are  seen  in  hospitals.  I  would  point  out,  however,  that  this  is  not 
true  of  the  out-patient  department  and  that  there  are  opportunities  in  the  out- 
patient department  to  meet  with  and  observe  the  early  stages  of  disease.  I  am  quite 
of  the  opmion  that  the  whole  question  of  full  time  clinicians  in  hospitals  is  still  an 
open  one.  I  merely  feel  that  theoretically  the  arguments  are  so  strongly  in  favor  of 
the  desirability  of  full  time  clinicians,  provided,  of  course,  that  they  have  gone 
through  a  training  that  has  acquainted  them  with  the  early  stages  of  disease,  that  I 
believe  the  plan  should  be  very  carefully  tried  out.  I  am  satisfied  that  the  plan  you 
suggest  putting  into  effect  will  be  a  great  improvement  over  the  former  one. 

Dr.   Henry  A.  Christian 

Peter  Bent  Brigham  Hospital 

Boston 

(i)  I  consider  a  paid  service  in  a  hospital  preferable  to  a  voluntary  service,  for 
the  reason  that  it  places  the  hospital  in  the  position  of  obtaining  a  more  adequate 
service  from  its  attending  staff.  A  continuous  service  appears  to  me  to  be  very 
essential  in  the  modern  hospital,  and  it  seems  unreasonable  to  ask  the  large  amount  of 
time  required  in  continuous  service  unless  the  service  is  remunerated  by  salary.  In 
paying  salary  for  the  service,  it  seems  to  me  that  the  hospital  is  in  far  better  position 
to  hold  its  attending  staff  up  to  certain  requirements  as  to  visits  and  character  of  the 
work.  With  close  attention  to  the  work  and  a  continuous  service,  it  seems  inevitable 
to  me  that  the  service  will  become  a  productive  one  along  the  lines  of  research,  and 
that  the  patients  will  receive  better  care  and  more  thorough  study,  leading  to  better 
diagnosis. 

(2)  It  seems  to  me  that  the  plan  suggested  by  you  provides  an  acceptable  means 
of  securing  a  paid  service. 

(3)  I  regard  the  arrangement  of  the  proportion  of  salaries  between  the  colleges 
and  the  City  as  satisfactory,  and  believe  that  this  new  arrangement  will  both  increase 
the  efficiency  of  the  Hospital  work  and  materially  improve  medical  instruction. 

(4)  I  have  no  particular  objections  to  offer  to  the  plan  as  set  forth,  but  I  think 
that  in  some  respects  it  is  not  definite  enough.  This  is  particularly  in  relation  to  the 
Superintendent  of  the  Hospital.  In  my  judgment,  the  usual  autocratic  position  of 
the  superintendent  is  one  that  does  not  make  for  the  best  work  in  the  hospital. 
I  would  seriously  question  the  advisability  of  clause  2,  which  places  the  control  of 
admissions,  distribution,  discharges,  and  social  service  entirely  under  the  charge  of 
the  Superintendent.  I  believe  that  the  Superintendent  should  be  the  executive  in 
regard  to  these  matters,  but  that  he  should  be  the  executive  under  rules  and  regula- 
tions drawn  up  by  the  Advisory  Committee  provided  in  clause  3,  which  rules  should 
not  become  effective  until  approved  by  the  Board  of  Trustees.  I  believe  that  the 
Advisory  Committee  provided  under  clause  3  should  have  more  of  a  function  than 
is  suggested  in  your  arrangements.  I  think  it  should  be  provided  that  all  matters 
concerning  the  policy  of  the  institution  and  the  administration  of  the  various  depart- 
ments, executive  and  professional,  should  be  submitted  to  this  Advisory  Committee 
prior  to  being  presented  to  the  Board  of  Trustees,  and  the  Board  of  Trustees  should 
not  take  action  upon  such  matters  until  they  have  had  a  report  from  the  Advisory 
Committee.  Furthermore,  it  should  be  provided  that  the  Advisory  Committee  in  case 
there  is  a  considerable  difference  of  opinion  should  have  access  by  means  of  a  repre- 
sentative to  the  Board  of  Trustees  to  present  respectively  the  majority  and  minority 
sides  of  the  question.  Furthermore,  I  believe  that  provision  should  be  made  so 
that  the  Medical  Service  and  the  Surgical  Service  and  the  Pathological  Service  should 
always  have  as  free  access  to  the  Board  of  Trustees  as  does  the  Superintendent. 
In  other  words,  the  present  custom  of  having  the  Superintendent  act  as  spokesman 
to  the  Board  of  Trustees,  which  is  a  method  generally  in  vogue,  is  undesirable. 
All  of  these  suggestions  tend  toward  making  the  Superintendent  the  administrator 
of  the  Hospital,  and  to  give  him  definite  duties  in  this  regard,  and  to  make  his  posi- 
tion coordinate  with  the  various  Chiefs  of  Staff.  There  is  absolutely  no  reason  why 
the  Staff  should  in  any  sense  of  the  word  be  subordinate  to  the  Superintendent,  and 
that  custom  generally  in  vogue  in  our  hospitals  is  to  my  mind  totally  indefensible, 
when  a  continuous  paid  service  exists. 


REORGANIZATION   OF  MEDICAL  SERVICE  753 

In  regard  to  clause  8,  I  think  there  should  be  inserted  a  provision  so  that  these 
various  men  could  not  be  discontinued  by  the  Trustees  except  for  cause  and  after  a 
hearing. 

Your  plan  does  not  make  any  provision,  it  seems  to  me,  for  the  organization  and 
management  of  the  very  large  number  of  special  laboratories  required  in  the  modern 
hospital  apart  from  the  pathological  laboratory.  For  instance,  a  medical  service  needs 
various  forms  of  laboratories  for  investigation  of  patients,  and  these  should  be  directly 
under  the  control  of  the  medical  service.  The  arrangement  with  a  pathologist  as 
director  of  the  laboratories  in  control  of  all  of  this  work  does  not  seem  to  me  to  have 
been  a  success  in  most  of  our  American  hospitals.  The  laboratory  is  just  as  much  a 
part  of  the  medical  work  as  the  wards,  and  should  be  so  regarded.  The  chief  of 
the  medical  service  cannot  adequately  handle  his  patients  unless  he  can  direct  the 
laboratory  work.  This  does  not  refer  to  the  question  of  performance  of  autopsies, 
pathological  examination  of  organs  and  tissues,  and  a  number  of  the  forms  of  serum 
diagnosis  and  bacteriological  study  which  should  be  done  -equally  well  under  the  direc- 
tion of  the  pathologist,  and  probably  better,  but  it  refers  to  such  matters  as  various 
chemical  examinations,  electrocardiography,  studies  of  respired  air,  etc.,  and  the  more 
ordinary  routine  laboratory  examinations  of  blood,  urine,  and  feces. 

Notwithstanding  these  criticisms  which  I  have  made,  I  believe  the  plan  is  a 
splendid  one,  and  represents  a  very  distinct  advance  in  the  organization  of  Bellevue 
Hospital,  an  advance  which  should  be  imitated  in  many  other  hospitals  in  this 
country. 

Dr.  Simon  Flexner 

Director  of  the  Laboratories 

The  Rockefeller  Institute  for  Medical  Research 

New  York 

I  am  unable  to  answer  all  your  questions,  since  regarding  many  of  the  points  raised 
I  am  not  in  a  position  to  advise.  I  am,  however,  persuaded  that  a  continuous  paid 
professional  service  would  provide  a  far  better  service  to  the  Hospital  than  the  pres- 
ent arrangement. 

Dr.  Graham  Lusk 

Department  of  Physiology 

Cornell  University  Medical  College 

New   York 

In  1909  I  wrote  the  following: 

"A  scheme  for  the  redemption  of  New  York  from  reproach  is  this :  Raise  a  fund 
of  $500,000.  Pay  the  professor  of  medicine  half  the  income,  or  $10,000  a  year,  in 
return  for  which  he  shall  spend  half  his  day  from  9  in  the  morning  to  i  o'clock 
instructing  students,  making  rounds  in  the  hospital,  and  supervising  research  work. 
He  should  have  under  him  two  assistants  at  $2,500  per  annum,  who  should  be 
permanent  resident  internes  of  the  hospital  and  men  who  can  grow  to  be  professors 
of  medicine.  The  $5,000  income  remaining  should  be  used  for  the  expenses  of  research 
at  the  discretion  of  the  professor." 

This  plan  was  intended  for  a  hospital  under  New  York  conditions.  The  salaries 
were  placed  high  in  order  to  attract  men  in  medicine  of  the  quality  of  Herter,  Edsall, 
Janeway,  or  Rowland.  It  was  believed  that  the  adoption  of  such  a  plan  would  give 
to  any  school  or  hospital  the  leadership  of  the  country  in  medicine.  It  seems  wise 
that  the  hospital  should  share  in  the  cost  of  an  establishment  which  would  so  enhance 
its  reputation  and  the  welfare  of  its  patients. 

Salaries  of  five  thousand  dollars  for  the  service  of  chief  physician  and  surgeon  are 
sufficient  to  make  a  workable  scheme  with  which  to  start,  but  are  insufficient  to  render 
the  positions  the  great  medical  and  surgical  prizes  of  the  country,  as  they  should  ulti- 
mately become  in  such  a  hospital  as  Bellevue  and  such  a  city  as  New  York.  If  one 
or  more  of  the  colleges  be  wise  enough  to  grasp  the  opportunity  they  can,  at  any 
rate,  provide  whatever  additional  salary  be  necessary  to  obtain  men  whose  leadership 
would  mean  medical  supremacy  in  the  United  States. 

Leadership  can  never  be  obtained  through  the  old  fashioned  types  of  "good,  prac- 
tical men."     Such  there  are  to-day  aplenty.    It  must  be  obtained  through  men  tutored 


754  HOSPITAL   COMMITTEE 

• 
in  the  modern  scientific  school.  In  the  latter  class  there  are  a  few  good  young  men; 
only  a  few,  unfortunately,  for  the  upbringing  of  the  vast  majority  of  medical  students 
has  been  in  an  atmosphere  in  which  emphasis  has  been  more  upon  the  commercial 
than  upon  the  intellectual  or  scientific  side  of  medicine.  The  average  clinician  is 
guided  by  his  impressions.     Scientific  facts  do  not  often  enter  seriously  into  his  mind. 

It  is  beyond  all  doubt  desirable  to  change  the  medical  atmosphere  and  to  cultivate 
the  intellectual  and  scientific  appreciation  of  the  diseased  organism.  This  should  be 
possible  in  a  great  hospital. 

In  any  plan  to  promote  the  welfare  of  the  hospital  it  is  necessary  that  the  physician 
should  profit  by  the  criticism  offered  by  the  pathologist.  The  pathologist  also  should 
be   responsible  for  the  routine   examinations   in   the  wards. 

But  it  is  essential  that  the  medical  and  surgical  heads  of  divisions  be  in  a  position 
to  control  investigations  into  the  cause  and  cure  of  disease.  Otherwise  there  would 
be  no  satisfactory  scientific  life;  no  work  which  would  make  the  wards  the  glory 
of  a  master  mind  in  charge. 

It  is  well  to  look  the  situation  squarely  in  the  face  and  seek  the  best  that  the 
world  offers.  It  is  of  primary  necessity  to  put  aside  the  inherited  defects  of  an 
antiquated  system  which  hinders  the  proper  development  of  medical  knowledge. 

Dr.  John  Rowland 

The  Johns   Hopkins  Hospital 

Baltimore 

I  have  not  been  well  for  several  weeks  and  thus  have  been  prevented  from  answer- 
ing your  communication  in  regard  to  the  proposed  plans  for  Bellevue  and  Allied 
Hospitals.  I  understand  that  matters  have  changed  considerably  and  that  answers 
to  your  questions  of  December  15th  would  not  be  pertinent  now.  I  should  only  like  to 
say  that  I  am  in  favor  of  compelling  the  medical  schools  to  assume  their  proper 
responsibility  in  the  conduct  of  the  medical  services  of  the  hospital  and  that  I  am 
distinctly  in  favor  of  a  paid  staff. 

Dr.   T.  W.   Hastings 
New   York 

In  Section  V,  the  natural  inference  would  be,  that  the  Chief  of  the  Medical 
and  the  Chief  of  the  Surgical  Services,  for  the  medical  school,  would  be  the  professors 
of  medicine  and  surgery.  A  man  of  more  than  ordinary  ability  and  of  high  attain- 
ment could  not  be  asked  to  accept  such  a  salary  as  suggested.  It  would  be  absurd 
even  if  the  medical  school  increased  it  threefold;  since  the  same  Section  V  states 
that  such  a  chief  must  serve  not  less  than  half  of  each  day,  or  not  less  than  four 
consecutive  hours. 

From  past  experience  at  Bellevue  one  knows  that  the  time  required  for  thoroughly 
covering  three  medical  wards  is  variable.  With  several  "new  admissions,"  or  even  a 
few  patients  desperately  ill,  one  ward  might  require  two  hours  attention,  while  the 
other  two  wards,  if  running  "light,"  might  not  require  more  than  15  or  20  minutes 
each.  For  one  interested  in  the  work,  however,  the  freedom  from  practice  which  such 
a  position  would  guarantee,  would  permit  considerable  time  to  be  given  to  hospital 
service,  in  work  connected  with  the  medical  wards,  such  as  laboratory  investigation, 
and  post  mortem  examinations  at  the  morgues. 

It  seems  to  me  that  the  four  consecutive  hours  might  be  defined  in  advance,  or  it 
should  be  understood  that  considerable  latitude  in  the  kind  of  service  should  be 
granted.  It  is  certain  that  the  places  will  be  best  filled  by  some  of  the  younger,  well- 
trained  medical  men. 

In  Section  IX,  the  demand  that  the  medical  colleges  should  be  responsible  for 
an  assistant  in  pathology  is  excellent,  since  the  work  of  the  Pathological  Department 
is  excessive  and  calls  for  a  large  staff,  and  is  essentially  necessary  for  proper  instruc- 
tion of  medical  students.  There  is  every  reason  in  the  world  why  medical  schools 
should  share  in  the  expense  of  conducting  a  pathological  division.  To  this  Section 
IX.  however,  should  be  added  that  the  Director  of  the  pathological  laboratory  should 
have  supervision  of  the  morgue,  located  in  the  new  pathological  building,  and  that 
the  morgue  records  be  accessible  to  the  Director  at  any  time,  for  the  use  of  the 
attending  staff,  particularly  in  relation  to  patients  who  have  died  from  unknown 
causes  and  have  been  classified  as  Coroner's  cases.  It  should  also  be  insisted  upon, 
if  possible,  that  the  new  morgue  be  utilized  at  an  early  date. 


REORGANIZATION    OF  MEDICAL   SERVICE  755 

Dr.  W.  G.   MacCallum 

Columbia   University 

Department  of  Pathology 

College  of   Physicians  and   Surgeons 

New  York 

Of  course  the  primary  object  being  the  proper  care  of  the  sick,  it  is  obvious  to  all 
who  have  had  experience  of  both  plans  that  this  is  best  attained  by  the  most  intimate 
possible  relations  with  the  university  medical  school,  not  only  because  the  best  avail- 
able men  are  there,  but  because  with  their  facilities  for  the  care  of  the  sick,  and 
with  the  incentive  furnished  by  teaching  from  the  patients,  those  patients  are  more 
intelligently  and  assiduously  treated.  I  therefore  find  it  deplorable  that  the  Fourth 
Division  should  continue  to  exist  without  connection  with  any  medical  school.  I 
cannot  see  that  there  can  be  any  reason  for  it  except  the  gratification  of  a  few 
men  who  wish  to  use  the  Hospital  for  their  private  good,  and  I  am  told  that  even 
in  that  Division  such  men  as  Dr.  Alexander  Lambert  feel  the  necessity  for  teaching 
and  actually  use  their  services  in  this  way  in  connection  with  some  college. 

I  cannot  see,  however,  that  any  high  degree  of  efficiency  is  ever  to  be  attained  as 
long  as  there  are  three  colleges  jealously  struggling  with  one  another  in  the  Hospital 
for  selfish  reasons.  If  these  colleges  could  he  amalgamated  into  one  and  that  one 
given  charge  of  the  Hospital,  every  difficulty  of  organization  would  fall  away  at 
once.  But  if  this  is  impossible,  it  seems  that  the  same  end  might  be  reached  by  giving 
over  the  whole  Hospital  to  one  of  the  colleges,  preferably  one  of  those  immediately 
adjacent  to  it,  since  the  college  which  had  control  of  such  a  splendid  material  would 
soon  overtop  the  others  and  constitute  itself  the  one  desirable  center  of  medical 
education  in  New  York. 

The  main  point  in  all  this  is  that  there  should  be  a  single  headed  organization, 
eliminating  conflicting  factors.  Of  course  it  might  be  possible  to  establish  three 
separate  and  independent  university  hospitals  in  Bellevue,  but  I  think  that  would  en- 
tail an  extravagant  duplication  of  facilities  and  apparatus,  as  well  as  untold  complexi- 
ties of  organization.  Possibly  the  suggestion,  which  I  believe  has  already  been  made, 
will  go  far  toward  this  aim.  I  refer  to  the  plan  of  separating  Medical,  Surgical,  Ob- 
stetric, Pediatric  Services,  etc.,  and  putting  each  under  the  control  of  one  man  who 
shall  hold  office  throughout  the  year,  this  man  to  be  the  best  that  can  be  supplied 
by  any  of  the  three  schools.  In  that  case  the  Obstetrical  Service  would  be  con- 
trolled by  the  appointee  of  one  school,  the  Medical  Service  by  that  of  another.  Each 
department  could  then  be  organized  with  the  same  perfection  as  a  part  of  an  ideal  uni- 
versity hospital. 

But  in  this  case  it  is  essential,  I  think,  that  the  college  should  be  given  the  power 
to  actually  appoint  this  head  of  a  department,  and  that  whatever  men  he  appointed 
as  his  assistants  should,  as  in  the  case  of  the  university  assistants,  be  nominated  to 
the  administration  committee  of  the  medical  school,  passed  on  by  the  faculty  and 
trustees  of  that  school,  and  ratified  by  the  Trustees  of  the  Hospital.  In  this  connec- 
tion there  should  be  at  least  one  member  common  to  the  Trustees  of  the  Hospital 
and  medical  school. 

With  regard  to  the  salaries  of  these  men,  I  think  the  apportionment  between  the 
City  and  the  college  fair  enough  from  a  financial  point  of  view,  but  with  the  above 
method  of  control  in  mind,  I  wish  to  especially  emphasize  the  fact  that  it  should  be  the 
college  that  directly  pays  the  salary  to  each  of  its  appointees,  the  City  paying  its  half 
into  the  treasury  of  the  college  for  this  purpose.  In  this  way  the  head  of  the  depart- 
ment is  directly  responsible  to  one  institution,  which  pays  him  his  salary.  He  can- 
not serve  two  masters,  and  if  his  instructions  and  criticisms  as  well  as  half  his  salary 
are  to  come  from  two  different  sources,  demoralization  is  sure  to  ensue.  The  criti- 
cisms and  instructions  f  rom_  the  City  as  to  the  conduct  of  the  department  should  be 
addressed  to  the  college,  which  should  then  impress  them  upon  its  appointee,  the  head 
of  the  department,  for  further  transmission  to  his  staff. 

Of  course  I  think  a  paid  service  preferable  to  a  voluntary  service,  because  it  intro- 
duces a  greater  sense  of  obligation  and  responsibility,  but  more  particularly  because 
it  is  only  the  very  exceptional  wealthy  enthusiast  who  can  devote  all  his  energies 
to  hospital  work,  as  he  should,  without  an  adequate  salary  to  keep  him  alive.  There 
is  no  other  man  who  can  support  himself  and  give  an  amount  of  attention  to  hospital 
work  which  would  justify  his  being  appointed  as  head  of  a  department  in  Bellevue,  and 
the  acceptance  of  a  hospital  appointment  for  the  mere  prestige  and  its  benefits  to  the 
appointees'  private  practice  is  inevitably  deleterious  to  the  hospital. 


75(1  HOSPITAL   COMMITTEE 

The  other  questions  are  answered,  I  think,  in  what  I  have  said.  These  remarks 
apply  precisely  to  the  pathological  laboratory  also — it  seems  doubtful  that  without  any 
voice  in  appointments  and  management  of  the  laboratory  work  of  the  Hospital, 
each  college  department  of  pathology  should  send  a  man  to  carry  on  its  routine.  On 
account  of  the  admirable  personality  of  the  present  Director  of  the  Laboratory,  Dr. 
Norris,  I  should  undoubtedly  be  glad  to  do  exactly  what  you  suggest  now,  but  in 
principle  I  think  that  plan  is  not  acceptable. 

Dk.  George  Emerson  Brewer 
New  York 

1st.  I  do  not  consider  a  paid  service  preferable  to  a  voluntary  service,  for  the 
reason  that  a  hospital  which  offers  the  advantages  and  facilities  of  the  new  Bellevue, 
will  attract  the  very  best  talent  in  the  community  without  pay  of  any  kind ;  provided 
you  will  make  the  service  an  attractive  one,  and  one  from  which  they  can  reap  a  fair 
amount  of  personal  benefit  in  the  way  of  experience,  gathering  statistics,  publishing 
reports,  and  teaching. 

In  other  words,  give  one  man  on  each  Medical  and  Surgical  Division  a  continuous 
service,  making  him  physician-  or  surgeon-in-chief ;  next  give  him  plenty  of  assistants, 
so  that  the  minor  details  in  the  actual  care  of  the  patients  shall  not  be  too  onerous  for 
the  Chief.  This  will  enable  him  to  give  his  attenton  to  the  great  problems,  to  person- 
ally assume  the  care  of  the  graver  cases,  and  in  addition  will  give  him  enough  time 
to  devote  to  the  organization  and  general  management  of  his  Division,  and  to  secure 
the  best  results  through  efficient  service  and  team  work  on  the  part  of  his  subordi- 
nates. Offer  such  a  service  to  the  very  best  men  in  the  community,  and  you  will 
see  that  they  will  gladly  accept  and  will  serve  loyally  without  pay,  and,  if  necessary, 
give  up   any  other  hospital  appointment  which  they   may  hold. 

2nd.  The  plan  you  outline  will  provide  an  acceptable  service,  but  I  do  not  think  you 
will  get  the  very  best  men  at  the  head  of  each  department,  for  I  do  not  imagine  that 
any  man  who  would  add  greatly  to  the  reputation  of  your  institution  would  be 
willing  to  accept  a  salary,  or  be  bound  by  the  rules  you  have  formulated. 

3rd.  I  will  not  answer  this  question,  for  I  do  not  approve  of  paying  salaries  to  the 
visiting  staff.  I  consider  it  a  useless  expenditure  of  money.  I  do  favor,  however, 
paid  residents.  The  best  plan  to  my  mind  would  be  to  have  a  resident  and  an 
assistant  resident  on  each  Division.  I  think  you  could  obtain  the  services  of  a  well 
equipped  resident  for  $500,  provided  the  head  of  each  service  was  chosen  from  the 
most  distinguished  men  in  the  community.  Most  young  men  would  prefer  to  serve 
without  compensation  under  a  distinguished  surgeon,  than  to  accept  a  position  even 
with  a  large  salary  under  a  person  whose  name  does  not  carry  much  weight  in  the 
medical  community,  and  who  perhaps  w^ould  not  keep  the  standard  of  his  service 
at  the  highest  point.  It  may  be  necessary  on  large  services  to  appoint  an  assistant 
resident,  and  you  could  easily  get  one  for  $250  provided  he  might  eventually  be 
promoted  to  the  position  of  resident.  The  rest  of  the  ward  work  could  be  done 
by  internes,  preferably  by  advanced  students,  who  could  live  in  the  Hospital,  and 
devote  a  year  or  more  to  the  service. 

I  may  say,  in  passing,  that  at  the  present  time  the  medical  colleges  in  this  com- 
munity are  considering  the  plan  of  requiring  a  fifth  year  in  the  study  of  medicine,  and 
that  fifth  year  to  be  devoted  entirely  to  hospital  service,  the  student  during  this 
period  to  live  in  the  hospital  and  do  the  work  of  the  house  staff.  If  this  becomes  a 
State  law,  as  it  has  already  in  several  States,  vife  will  have  to  reorganize  our  methods 
of  interne  service,  and  it  seems  to  me  this  is  the  best  solution. 


Dr.  Robert  J.  Wilson 
Superintendent  of  Hospitals 

Department   of   Health 

of  the  City  of   New   York 

Division  of  Hospitals 

New   York 

1.  No. 

2.  No.     It  is  proposed  to  make  the  medical  colleges  equal  partners  with  the  City 
in  the  payment  of  the  salaries  of  the  medical  attendants  of  the  institution  but  allows 


REORGANIZATION   OF  MEDICAL   SERVICE  757 

them  no  option  either  in  the  administration  of   it  or  the  policy  of   retaining  their 
representatives. 

3.  No.    For  the  reasons  given  in  answer  No.  2. 

4.  My  objections  to  the  plans  as  outlined  are  twofold.  First,  I  believe  that  the 
colleges  will  supply  free  of  charge  the  best  medical  and  surgical  talent  that  they  have 
at  their  command,  and  that  they  will  see  to  it  that  their  representatives  give  as  much 
time  as  is  demanded  by  the  proposed  pay  scheme.  As  you  know,  these  positions 
of  attending  physicians  are  coveted  by  the  best  men  in  the  medical  faculties  (not 
necessarily  those  having  the  largest  practices)  and  the  opportunities  oflfered  by  the 
position  mean  far  more  to  them  than  the  monetary  consideration  proposed  to  be 
given   to  their   successors. 

I  am  of  the  opinion,  also,  that  every  medical  man  recommended  by  the  university 
is  looked  upon  by  it  as  a  direct  advertising  asset.  The  success  or  failure  that  attends 
his  efforts  in  the  hospital  service  reflects  directly  to  the  credit  or  discredit  of  the 
university  from  which  he  comes,  and  no  university  can  afford  either  from  a  scientific 
or  economic  standpoint  to  allow  an  unfit  representative  in  any  hospital  with  which 
it  has  connection.  The  salary  proposed  is  not  sufficiently  seductive  to  draw  surgeons 
or  physicians  who  now  enjoy  the  reputation  for  the  highest  skill,  and  is  just  high 
enough  to  be  attractive  to  those  of  mediocre  ability.  I  am  inclined  to  think  that 
the  level  of  the  institution  will  rise  just  to  the  height  of  the  medical  and  surgical 
ability  that  administers  it. 

My  other  reason  for  being  opposed  to  this  plan  is  that,  it  seems  to  me,  it  will 
limit  the  usefulness  of  the  institution  for  teaching  purposes.  If  the  Hospital  were 
owned  by  a  single  medical  school,  or  if  it  were  the  property  of  a  private  corporation, 
the  scheme  might  work.  For  all  of  the  medical  attendants  would  of  necessity  be  com- 
pelled to  get  their  appointments  from  the  governing  body  of  the  university  and  equally 
of  necessity  follow  out  the  line  of  work  as  detailed  to  them;  if  they  failed  in  this 
respect  the  governing  body  would  remove  them,  and  if  they  succeeded  the  governing 
body  would  commend  them;  but  in  this  proposed  scheme  the  university  has  not  the 
power  of  removal,  and  although  the  representative  of  their  own  selection  may  fail  to 
meet  the  requirements  of  the  college,  he  will  still  be  retained  in  his  position,  drawing 
money  that  they  have  to  pay  irrespective  of  their  wishes.     This  is  manifestly  unjust. 

The  first  four  years  of  my  administration  of  the  Health  Department's  Hospitals 
was  marked  by  a  paid  medical  attending  staff;  for  the  last  three  years  we  have 
had  a  volunteer  medical  board,  appointed  by  the  Board  of  Health,  which  has  had  full 
and  complete  charge  of  the  medical  service,  and,  so  far  as  I  can  see,  the  results 
obtained  are  equal  to,  if  not  better  than,  those  obtained  when  we  had  the  paid  staff, 
and  should  we  attempt  to  pay  for  ability  of  the  character  that  we  now  receive,  our 
budget  allowances  for  professional  services  would  have  to  be  far  greater  than  they 
now  are. 

I  think  the  scheme  as  proposed,  for  a  private  institution  where  there  is  no  con- 
flict of  authority  in  the  board  of  control  would  be  excellent,  but  it  seems  to  me  that 
in  an  institution  where  it  is  proposed  to  give  over  medical  control  with  the  responsi- 
bility of  paying  for  it  to  one  set  of  people  and  administrative  control  to  another  set 
of  people,  neither  of  which  have  any  common  interest,  would  be  a  mistake.  After  all, 
the  only  people  to  be  actually  considered  here  are  the  patients,  and  they  should  have 
the  very  best  medical  and  surgical  attention  they  can  get.  This  is  not  obtained  by 
limiting  the  supply  to  a  few  positions  with  mediocre  salaries. 


Dr.  William  H.  Park 
New  York 

I  do  not  think  that  a  paid  service  is  preferable  to  a  voluntary  one  at  Bellevue 
Hospital.  The  reasons  for  this  opinion  are  that  the  colleges  either  do  or  can  be  com- 
pelled to  have  the  attendants  give  sufficient  time  to  their  services.  It  is  very  important 
for  the  colleges  to  use  the  Bellevue  service  to  give  good  training  to  their  men.  This 
is  especially  true  for  the  University  and  Cornell  Medical  Colleges.  I  know  that 
it  is  perfectly  possible  to  have  capable  men  giving  sufficient  hours  both  for  the  patients 
and  for  the  students.  I  think  that  the  plan  advised  would  also  secure  capable  men. 
It  would,  however,  in  my  opinion  be  an  unnecessary  expense  to  both  the  colleges  and 
the  City.  If  adopted,  I  do  not  think  that  it  is  the  best  policy  to  apply  half  of  this 
expense  to  the  colleges.  In  the  middle  west  the  people  are  more  and  more  coming  to 
consider  that  medical  education  is  the  duty  of  the  state  and  should  be  supervised  and 
supported  by  the  people.    The  long  and  expensive  education  now  required  is  solely  for 


758  HOSPITAL   COMMITTEE 

the  good  of  the  people,  and  adds  expense  and  no  income  to  the  universities.  The 
medical  schools  are  now  a  great  financial  drain  on  their  universities  and  no  school  can 
now  depend  on  fees  for  its  expenses.  Germany  and  France  have  also  adopted  the 
principle  of  the  state  largely  supporting  medical  education.  I  think  to  add  this  drain  to 
the  medical  schools  will  cripple  the  other  activities.  It  is  urgently  required  that  some 
pay  be  given  the  physicians  in  the  Out-Patient  Department. 

The  opinions  I  have  here  expressed  are  my  own  opinions.  I  have  talked  these 
matters  over  with  a  number  of  prominent  physicians  and  surgeons  who  are  connected 
with  hospitals  and  the  great  majority  agree  with  me. 

One  objection  made  by  many  is  requiring  four  hours  of  compulsory  surgical 
service  each  day.  This  would  interfere  with  a  man  carrying  out  private  practice  more 
than  is  wise  and  might  prevent  the  obtaining  of  men  of  the  first  rank.  An  average 
of  four  hours  service  would  allow  the  necessary  time  and  be  much  more  acceptable 
to  suitable  men.  Each  man  should  have  permanent  assistants  who  could  be  delegated 
to  do  the  simpler  operations  and  care  for  the  less  difficult  cases.  My  objection  so  far 
as  expense  is  concerned  would  hold  for  requiring  the  college  to  support  a  pathologist. 
In  this  case  I  think  it  would  be  fair  to  ask  the  college  to  pay  half  the  fee.  This 
sum  would  be  small  and  the  pathologist  would  take  care  of  a  necessary  part  of  the 
college  teaching  which  is  now  paid  for.  In  other  respects  I  think  the  report  is 
acceptable. 

De.  John  B.  Murphy 
Chicago 

2.  I  feel  that  the  admission  and  distribution  of  patients  should  be  entirely 
under  the  charge  of  a  superintendent  under  a  definite  plan  of  outline;  that  the  dis- 
charges should  be  made  by  the  superintendent  and  on  the  suggestion  or  order  of  the 
attending  physician. 

3.  All  advisory  boards  that  I  have  had  anything  to  do  with  in  hospital  man- 
agement for  the  past  four  years  have  been  either  purely  ornamental  or  officially 
detrimental. 

4.  The  out-patient  department  should  be  subdivided  so  as  to  work  in  with 
the  subdivisions  of  the  ward  service. 

5.  The  salaries  that  you  suggest  should  not  be  sufficient  to  secure  the  class 
of  men  that  you  can  have  voluntarily  free,  nor  should  they  give  you  as  good  a 
service.  There  is  no  man  in  Chicago  of  prominence  in  the  profession  who  accepts  a 
voluntary  free  service  in  a  hospital  that  does  not  give  it  the  best  of  his  time  and 
attention.  I  feel  that  the  salary  mentioned  could  not  possibly  secure  such  men  and 
such  service  for  the  patients  as  they  receive  now  gratuitously.  In  our  County  Hospital 
arrangement  we  have  a  very  definite  requirement  as  to  attendance,  etc. 

6.  A  partnership  with  a  medical  school  or  with  many  medical  schools  would, 
in  my  opinion,  be  a  very  undesirable  thing  for  the  City  of  New  York  or  for  the  Board 
of  Charities. 

7.  The  method  of  selecting  internes,  I  think,  is  a  good  one  and  should  be  con- 
ducted by  written  examinations  and  on  a  secret  plan. 

8.  I  think  the  powers  of  the  Trustees  should  be  restricted,  and  that  a  man's 
service  should  not  be  discontinued  without  a  hearing  both  before  the  staff  and  the 
Board  of  Trustees.  Trustees  and  doctors  are  all  human  and  they  become  entangled 
in  their  relationships,  and  a  great  injustice  might  be  done  to  the  patients  as  well  as 
to  the  doctors  if  star  chamber  proceedings  were  permitted.  Furthermore,  every  man 
of  ability  would  very  seriously  question  accepting  a  salary  and  taking  a  position, 
if  he  felt  it  might  be  discontinued  without  a  just  and  adequate  hearing  and  presenta- 
tion of  his  case. 

9.  Pathological  Department:  The  outline  for  this  work  appears  to  be  a  good 
one,  except  that  I  would  insist  that  students  be  invited  to  attend  the  autopsies  or  that 
they  be  forced  to  attend  them  regularly.  No  autopsy  should  be  made  without  the 
presence  of  from  four  to  six  students,  as  this  is  one  of  the  greatest  means  of  educa- 
tion at  our  command,  and  it  is  very  much  to  be  regretted  that  the  large  cities  are 
permitting  this  incomparable  opportunity  for  education  to  be  overlooked  at  the  present 
time.  The  salary  for  the  pathologist  seems  too  low.  We  would  gladly  pay  double 
that  amount  for  a  pathologist  at  Mercy  Hospital  at  the  present  time,  and  we  are 
unable  to  find  one.  Unless  the  remuneration  is  increased,  men  will  not  devote  them- 
selves to  that  line  of  labor  for  a  livelihood,  as  there  is  no  livelihood  in  it. 

Now,  taking  up  the  questions  in  your  letter,  I  would  answer  them  as  follows : 


REORGANIZATION   OF  MEDICAL  SERVICE  759 

1.  I  do  not  consider  a  paid  service  equivalent  to  a  voluntary  service,  providing 
the  voluntary  service  is  properly  arranged  and  the  work  properly  classified  and  out- 
lined. 

2.  The  plan  does  not  appear  to  me  as  providing  an  acceptable  means  of  securing 
a  paid  service.  It  is  trouble  enough  to  get  along  with  one  college,  let  alone  two  or 
three. 

3.  The  salaries  are  entirely  inadequate  to  the  service  required. 

4.  I  do  not  believe  that  you  can  secure  as  good  service  under  your  paid  plan  as 
you  could  without  paying,  providing  each  attending  physician  or  surgeon  is  assigned 
a  definite  and  continuous  ward  service  for  life,  if  his  services  are  up  to  standard. 
He  should  have  a  competent  associate  or  co-worker — associate,  I  believe,  is  the  better 
name — and  then  he  should  also  have  one  or  two  assistants.  If  these  positions  are  made 
permanent  life  positions,  with  a  continuous  service,  there  is  no  man  so  big  that  he 
can  afford  to  refuse  them,  and  no  small  man  can  possibly  fill  them. 

There  should  be  definite  hours  of  attendance,  two  or  three  a  day,  as  the  case  may 
be,  and  the  same  hours  or  more  should  hold  for  the  associate  and  assistants.  Have 
the  wards  called,  for  instance,  Dr.  Jones'  service  or  Dr.  Brown's  service.  With  the 
hospital  service  made  up  of  a  number  of  units  of  this  class,  there  immediately 
begins  a  spirited  competition  as  to  which  service  will  give  the  best  results  to  the 
people;  the  best  scientific  training;  make  the  best  diagnoses;  and  make  the  best  opera- 
tions with  the  best  final  results.  That  will  be  a  spirited  rivalry  that  will  stimulate 
a  keen  interest  in  all  of  the  work  of  the  departments.  When  a  man  feels  that  he  is 
secure  in  his  position,  he  renders  competent  service;  when  he  feels  that  he  is  inse- 
cure, regardless  of  service  rendered,  then  it  is  always  a  meager  and  stinted  one. 

In  my  association  with  the  Cook  County  Hospital,  which  has  been  first  as  interne, 
second  as  attending  man  for  20  years,  and  third  as  consultant  for  thirteen  years,  my 
observations  have  been  that  the  continuous  service  with  individual  responsibility  for 
a  ward  or  a  division  is  what  has  made  for  the  best  results. 

I  have  endeavored  in  this  meager  way  to  give  you  my  impressions  concerning 
the  hospital  work  that  has  come  under  my  observation.  I  trust  it  will  be  of  assistance 
to  you. 


SOME  PROBLEMS  COMMON  TO  ALL  THE 
DEPARTMENTS 


THE  PROBLEM  OF  ADMINISTERING  THE  MUNICIPAL  HOSPITALS 

New  York  City  at  present  operates  eighteen  hospitals.  Of  these,  four 
are  operated  by  the  Department  of  Bellevue  and  Allied  Hospitals ;  four  by 
the  Department  of  Health;  and  ten  by  the  Department  of  Public  Charities. 
The  question  naturally  arises,  Why  this  division  of  authority  ?  The  division 
is  due  partly  to  a  natural  development  and  partly  to  an  arbitrary  separa- 
tion: the  Health  Department  having  jurisdiction  over  contagious  cases 
naturally  developed  hospitals  for  their  care;  Bellevue  and  its  allied  hos- 
pitals were  arbitrarily  and  by  a  special  act  separated  from  the  Department 
of  Public  Charities  in  1902.  This  was  done  in  the  belief  that  better  man- 
agement of  these  hospitals  would  result. 

The  Health  Department  cares  for  contagious  cases,  including  tuber- 
culosis; Bellevue  and  its  allied  hospitals  are  supposed  to  treat  only  acute 
non-contagious  cases,  but  do  care  for  tuberculosis,  pneumonia,  typhoid, 
syphilis,  and  some  other  contagious  and  infectious  diseases;  the  hospitals 
of  tfie  Department  of  Charities  are  of  the  same  character  as  those  of 
Bellevue  Department,  except  that  they  treat  more  chronic  and  tuberculosis 
cases. 

It  is  held,  and  rightly,  that  this  division  of  authority  is  illogical;  but 
some  illogical  arrangements  do  work.    The  situation  needs  analysis. 

Each  of  the  Departments  administers  its  hospitals  reasonably  well,  but 
there  are,  however,  some  shortcomings  due  to  a  conflict  of  authority. 

When  Bellevue  and  its  allied  hospitals  were  separated  from  the  Depart- 
ment of  Public  Charities  it  was  with  the  idea  that  the  hospital  problem  of 
Manhattan  and  The  Bronx  would  be  handled  by  the  Bellevue  Department. 
It  was  intended  that  the  hospitals  on  Blackwell's  Island  under  the  De- 
partment of  Charities  should  continue  to  care  for  the  chronic  cases,  and 
to  these  hospitals  the  Bellevue  Department  hospitals  would  transfer  all  long- 
term  cases.  The  Brooklyn  and  Queens  hospital  problems  were  to  remain 
under  the  jurisdiction  of  the  Department  of  Public  Charities.  This  division 
probably  would  have  worked  well  had  the  Blackwell's  Island  hospitals  re- 
mained solely  chronic  hospitals. 

The  attending  staff  and  nursing  schools  at  these  hospitals  from  time 
to  time  brought  pressure  upon  the  Commissioner  of  Charities  to  give  them 
an  acute  service,  that  they  might  thereby  receive  a  more  varied  practice. 
As  a  result  of  this  pressure  Commissioner  Drummond,  in  1910,  established 
at  the  foot  of  East  70th  Street  a  Reception  Hospital,  which  in  character 
is  an  emergency  station,  operating  an  ambulance.  The  Board  of  Ambu- 
lance Service  was  induced  to  readjust  the  ambulance  districts  so  as  to  as- 
sign a  district  to  the  Reception  Hospital.  The  entire  district  formerly 
assigned  to  the  Presbyterian  Hospital  and  a  portion  of  the  Flower  Hospital 
and  the  Harlem  Hospital  districts  were  combined  to  form  the  Reception 
Hospital  district.  The  cases  received  at  the  Reception  Hospital  were  trans- 
ferred by  boat  to  City  and  Metropolitan  Hospitals.  The  change  in  char- 
acter of  the  service  of  these  two  Blackwell's  Island  hospitals  is  somewhat 
indicated  by  the  increase  in  the  number  of  their  surgical  cases.  Their 
records  for  wounds,  trauma,  amputations,  fractures,  sprains,  burns,  dislo- 
cations, cellulitis,  abscesses,  and  concussions  of  brain,  appear  as  follows : 

763 


764  HOSPITAL   COMMITTEE 

1909  1911 

Number  Number 

of  of 

Cases  Cases 

Metropolitan  Hospital 402  634 

City  Hospital 546  706 


Thus,  the  acute  cases  of  Manhattan  which  were  formerly  assigned  to 
Bellevue  and  its  allied  hospitals  are  now  divided  with  the  hospitals  of  the 
Department  of  Public  Charities. 

Whether  it  was  and  is  necessary  for  the  Island  hospitals  to  develop  an 
acute  service  in  order  to  secure  a  good  attending  staff  and  to  give  a  satis- 
factory training  to  nurses  is  an  open  question.  A  chronic  service  is  not  at- 
tractive to  internes,  but  is  appreciated  by  older  practitioners ;  and  while  a 
good  staff  probably  can  be  secured  for  a  chronic  service,  the  nursing  prob- 
lem is  not  so  readily  solved.  Pupils  get  but  a  partial  training  from  a 
chronic  service  and  are  little  inclined  to  enter  hospitals  furnishing  that 
service  only. 

On  the  other  hand,  the  pure  air.  and  freedom  from  noise  and  dirt 
make  Blackwell's  Island  the  choicest  spot  in  New  York  City  for  hospitals 
caring  for  acute  as  well  as  chronic  cases.  If  the  hospitals  on  the  Island 
are  to  be  developed  as  acute  hospitals  they  must  have  larger  ambulance 
territory,  which,  in  Manhattan,  must  be  taken  from  private  hospitals  or 
from  Bellevue  and  Harlem  Hospitals.  Here  arises  a  conflict  in  interests 
between  departments.  Manhattan  should  have  one  hospital  equipped  to 
care  for  even  the  rarest  injuries  or  diseases.  Equipment  and  facilities  of  this 
character  are  expensive  and  cannot  be  duplicated  economically,  but  such 
a  hospital  Bellevue  is  designed  to  be,  and  to  this  Hospital  all  rare  cases 
requiring  special  treatment  should  be  taken.  With  two  departments 
each  serving  the  same  territory  a  proper  distribution  and  classification  of 
cases  cannot  be  assured.  It  seems  somewhat  unwise  and  hazardous  to 
design  Bellevue  for  2,000  patients  and  equip  it  with  everything  which  can 
contribute  to  the  proper  treatment  of  injuries  or  diseases  without  being 
assured  that  it  will  have  enough  patients  to  occupy  the  beds  so  provided,  or 
that  the  cases  of  injuries  or  diseases  for  which  special  appliances  have  been 
provided  shall  be  received  into  it. 

According  to  the  division  of  authority  now  existing  the  Board  of  Am- 
bulance Service  can  diminish  the  extent  of  Bellevue's  ambulance  district, 
or  it  can  refuse  or  neglect  to  increase  it  when  the  enlarged  Bellevue  seems 
to  demand  it.  The  proportion  of  acute  cases  and  the  classification  of  such 
cases  which  should  go  to  Bellevue  or  to  the  hospitals  on  the  islands  in  the 
East  River  should  not  be  left  to  a  board  independent  of  both  Departments, 
and  which  may  be  more  favorable  to  one  Department  than  to  the  other. 

The  endeavor  of  the  Island  hospitals  controlled  by  the  Department 
of  Public  Charities  to  build  up  an  acute  service  is  not  discreditable,  nor, 
perhaps,  would  the  endeavor  be  open  to  much  criticism  if  the  policy  had 
been  adopted  openly  and  in  consultation  with  Bellevue  as  representing  the 
same  territory.  No  attempt  was  made  on  the  part  of  the  Department  of 
Public  Charities  when  opening  the  Reception  Hospital  at  East  70th  Street 


PROBLEMS  COMMON  TO  DEPARTMENTS  765 

to  reach  an  agreement  with  the  Bellevue  Department  as  to  ambulance  ter- 
ritory or  as  to  classification  of  cases.  It  was  an  independent  move,  irre- 
spective of  the  effect  upon  the  Bellevue  Department,  and  during  the  three 
years  that  it  has  been  in  operation  there  has  been  little  or  no  cooperation  be- 
tween the  Departments  dealing  with  this  phase  of  their  work. 

Previous  to  the  establishment  of  this  Reception  Hospital  the  nurses 
serving  in  City  Hospital  were  daily  transferred  to  Gouverneur  Hospital 
in  the  Bellevue  Department,  for  training  in  the  care  of  acute  cases.  By  this 
cooperative  program  the  nurses  were  given  a  very  acceptable  training  in 
the  care  of  both  chronic  and  acute  cases.  After  the  establishment  of  the 
Reception  H^ospital  this  program  of  cooperation  was  abandoned  and  the 
nurses  were  no  longer  given  an  opportunity  to  serve  in  Gouverneur  Hos- 
pital. 

It  has  been  difficult  to  secure  pupil  nurses  in  the  hospitals  on  Black- 
well's  Island  owing  to  the  fact  that  they  could  not  secure  the  experience  in 
connection  with  acute  cases  which  they  desired  and  should  have.  The 
establishment  of  the  Reception  Hospital  at  East  70th  Street  has  partially, 
but  by  no  means  wholly,  overcome  the  difficulty.  On  the  other  hand,  nurses 
serving  in  Bellevue  Hospital  have  received  training  almost  exclusively  in 
the  care  of  acute  cases.  This  does  not  give  them  a  rounded  experience  and 
they  are  sent  out  into  private  practice  with  comparatively  little  knowledge 
of  the  care  of  chronic  cases.  Again,  none  of  the  nurses  trained  in  either 
Bellevue  or  the  hospitals  of  the  Department  of  Public  Charities  have  ex- 
perience with  contagious  diseases,  since  these  are  cared  for,  with  but  rare 
exceptions,  in  the  hospitals  of  the  Department  of  Health. 

So  long  as  the  hospitals  are  more  or  less  specialized  in  three  separate 
and  distinct  departments  the  nurses  will  receive  an  unbalanced  training, 
some  receiving  specialized  training  in  acute  service,  others  in  chronic 
service,  and  still  others  in  the  care  of  the  contagious  cases.  Nurses  will  not 
receive  a  rounded  training,  with  experience  in  each  of  these  classes  of  cases, 
until  the  three  Departments  reach  some  basis  of  understanding  and  coopera- 
tion which  will  enable  nurses  to  be  trained  in  the  different  classes  of  hos- 
pitals. An  alternative  to  such  classification  or  speciahzation  of  hospitals 
would  be  to  provide  these  three  classes  of  services  in  all  hospitals ;  viz., 
acute,  chronic,  and  contagious. 

A  difficulty,  by  no  means  minor,  due  to  the  division  of  authority 
over  hospitals  arises  from  the  fact  that  the  Bellevue  Department 
has  no  powers  of  an  Overseer  of  the  Poor.  These  powers  reside 
solely  in  the  Commissioner  of  Charities.  By  Chapter  378,  Laws  of 
1897,  as  amended  by  Chapter  466,  Laws  of  1901,  the  Commissioner  of 
Charities  is  constituted  an  Overseer  of  the  Poor,  and  as  such  has  power 
to  dispose  of  all  unclaimed  bodies ;  to  administer  public  morgues ;  to 
deport  to  other  states  or  counties  dependents  not  having  a  residence  in 
the  counties  constituting  the  City  of  New  York ;  to  collect  from 
Overseers  of  the  Poor  of  other  counties  for  the  care  of  dependents 
cared  for  in  New  York  City  but  having  residence  elsewhere  in  the  State. 
There  is  need  for  the  exercise  of  these  powers  in  Bellevue  and  its  allied 
hospitals,  since  non-residents  are  received  by  these  hospitals,  and  the  lack  of 
these  powers  involves  the  Bellevue  hospitals  in  a  heavy  annual  expense  for 
the  care  of  non-residents. 

The  Department  of  Public  Charities  is  obliged,  by  the  City  Charter,  to 
receive  all  patients  which  the  Bellevue  Department  desires  to  transfer  to  it. 


j(£  HOSPITAL   COMMITTEE 

Friction  has  arisen  over  this  provision,  because  of  the  fact  that  the  Com- 
missioner of  Charities  endeavored  to  build  up  an  acute  service  in  his  De- 
partment, and,  accordingly,  attempted  to  reserve  beds  for  the  use  of 
such  cases.  It  became  the  practice  to  notify  Bellevue  each  day  of  the  num- 
ber of  cases  that  might  be  transferred,  and  the  number  of  beds  thus  re- 
ported seldom  was  sufficient  to  accommodate  the  patients  needing  transfer. 
Accordingly,  Bellevue  adopted  the  practice  in  not  a  few  instances  of  dis- 
charging patients  to  the  street  with  the  suggestion  that  they  apply  to  the 
Department  of  Charities  for  admission.  Should  they  make  direct  and  per- 
sonal appeal  to  the  Department  of  Charities  they  could  not  be  refused  ad- 
mission. Such  practice  was  objectionable,  but  it  seemed  to  the  Bellevue 
authorities  the  only  means  of  relieving  themselves  of  chronic  patients. 
The  Commissioner  of  Charities  no  longer  holds  to  this  practice.  Never- 
theless, the  possibility  remains  of  some  future  Commissioner  again  resorting 
to  the  practice,  much  to  the  detriment  of  Bellevue. 

The  Charter  is  not  clear  as  to  the  power  of  Bellevue  to  increase  its 
facilities  by  the  building  of  new  hospitals.  It  is  clear,  however,  as  to  such 
power  on  the  part  of  the  Department  of  Public  Charities.  Though  the 
Bellevue  Department  has  been  assigned  by  inference  certain  territory, 
nevertheless,  it  apparently  cannot  meet  the  growing  needs  of  the  City  by  the 
erection  of  new  institutions.  The  needs,  it  would  seem,  must  be  met  by 
the  Department  of  Public  Charities  invading  the  field  assigned  to  the  Belle- 
vue Department. 

At  present  there  is  no  cooperation  between  the  Deparbnents  of  Health, 
Charities,  and  Bellevue  and  Allied  Hospitals  in  the  use  or  assignment  of 
field  nurses  or  social  service  workers.  Nurses  from  the  three  Departments 
may,  and  do,  visit  the  same  neighborhoods,  and  perchance  the  same  families. 
It  might  readily  happen  that  three  members  of  one  family  would  simultane- 
ously be  in  hospitals  of  the  three  Departments  and  a  social  service  worker 
be  sent  from  each  hospital  to  the  one  home. 

Each  of  the  three  Departments  receives  and  cares  for  tuberculous 
patients  without  agreement  as  to  the  class  of  cases  received  by  each.  Since 
medical  records  are  not  exchanged  by  the  three  Departments  much  needless 
duplication  of  work  results.  The  Department  of  Health  maintains  tuber- 
culosis clinics  throughout  the  City.  Regardless  of  this  fact,  the  Commis- 
sioner of  Charities,  in  1913,  established  in  Brooklyn  a  tuberculosis  clinic 
which  in  a  large  measure  duplicated  the  work  done  by  the  Health  Depart- 
ment. No  consistent  policy  exists  for  the  handling  of  the  tuberculosis  prob- 
lem, and  none  seems  likely  to  be  established  so  long  as  three  non-cooperat- 
ing departments  are  adopting  conflicting  policies. 

The  Health  Department  is  opening  clinics  for  venereal  diseases,  although 
the  Departments  of  Bellevue  and  Public  Charities  receive  these  cases  into 
their  hospitals.  Whooping-cough  cases  are  received  by  the  Department  of 
Public  Charities,  and  also  treated  in  clinics  by  the  Department  of  Health. 
Though  the  Department  of  Health  operates  its  hospitals  presumably  for 
contagious  cases,  nevertheless,  all  cases  of  leprosy  are  cared  for  at  INIetro- 
politan  Hospital  by  the  Department  of  Public  Charities. 

The  number  of  cases  received  by  a  hospital,  either  private  or  public,  is 
in  a  large  measure  dependent  upon  the  size  and  character  of  its  ambulance 
territory.  The  ambulance  districts  are  determined  and  assigned  by  the 
Board  of  Ambulance  Service,  composed  of  five  members,  of  whom  three 
are  ex  officio  the  Commissioner  of  Charities,  the  President  of  the  Board 
of  Trustees  of  Bellevue  and  Allied  Hospitals,  and  the  Police  Commissioner. 


PROBLEMS  COMMON  TO  DEPARTMENTS  767 

The  remaining  members  are  appointed  by  the  Mayor.  Though  the  City  has 
adopted  the  policy  of  caring  for  all  dependent  and  emergent  cases  in  its 
municipal  hospitals,  nevertheless,  the  problem  of  assigning  ambulance  ter- 
ritory to  the  hospitals  is  in  the  hands  of  a  board  independent  of  the 
hospitals. 

No  consistent  policy  exists  for  the  care  and  treatment  of  the  sick.  It 
is  obvious  that  one  should  be  adopted.  Can  it  be  brought  about  while  they 
are  received  in  hospitals  operated  by  three  independent  and  non-cooperating 
departments?  This  is  a  question  which  has  often  been  asked.  The  Com- 
mission on  Hospitals  appointed  by  Mayor  McClellan  devoted  much  time  in 
an  attempt  to  answer  it  and  finally  made  a  recommendation  that  all  hos- 
pitals be  placed  under  the  control  of  one  department. 

The  problem  is  not  easy  of  solution.  There  is  no  inherent  reason  why 
hospitals  should  not  be  administered  by  three  departments,  provided  the  de- 
partments cooperated.  In  the  past,  however,  these  Departments  have  not 
met  on  a  common  ground  to  discuss  their  problems  and  to  agree  upon 
policies.  But  this  is  not  necessarily  due  to  the  fact  that  two  of  these  De- 
partments have  been  administered  by  Commissioners  appointed  by  the 
Mayor,  and  the  third  by  a  Board  of  Trustees  which  is  largely  independent 
of  the  Mayor,  for  the  two  Departments  headed  by  Commissioners  have  not 
cooperated,  nor  has  the  Department  of  Water  Supply,  Gas,  and  Elec- 
tricity, which  has  certain  powers  over  the  physical  plants  of  these  Depart- 
ments, cooperated  with  either.  In  the  past  the  Mayor  has  not  sought,  or 
has  not  been  able,  to  bring  his  Commissioners  on  to  a  common  ground.^  The 
proverbial  jealousies  of  medical  boards  have  some  foundation  in  fact  and 
must  be  reckoned  with.  Apparently  some  unified  power  is  needed  to  force 
a  consistent  policy.  It  seems  probable  that  such  force  must  take  the 
form  of  one  head  to  all  hospitals,  with  the  possible  exception  of  those  caring 
for  quarantinable  cases. 

Various  forms  of  consolidation  have  been  suggested.  The  most  com- 
prehensive is  that  every  department  of  the  City  dealing  with  public  health 
or  public  well-being  shall  be  consolidated  into  one  department.  According 
to  this  suggestion,  in  such  a  department  would  be  included  all  of  the  work 
now  performed  by  the  Departments  of  Health,  Bellevue  and  Allied  Hos- 
pitals, Public  Charities,  Public  Recreation  Commission,  Board  of  Inebriety, 
and  the  Board  of  Ambulance  Service.  The  functions  performed  by  these 
various  Departments,  Commissions,  and  Boards  overlap  in  quite  a  measure, 
and  are  correlated  in  many  ways.  Thus  it  would  be  logical  to  have  all 
of  these  functions  supervised  by  one  head,  and  by  such  an  arrangement 
many  of  the  conflicts  now  existing  in  fields  laclcing  definition  between 
the  Department  of  Health  and  the  Departments  administering  hospitals 
would  be  obviated.  It  would  also  simplify  some  of  the  problems  of  the 
Fire  Department  and  the  Police  Department.  At  the  present  time  these 
two  Departments  pay  for  the  services  of  physicians  to  care  for  their  em- 
ployees, and  these  physicians  are  required  to  go  to  various  parts  of  the 
City  to  attend  such  employees  while  sick  in  their  homes.  By  such  a  com- 
prehensive plan  as  suggested  above  the  district  physicians  of  the  proposed 
department  could  readily  perform  all  the  functions  now  performed  by 
the  physicians  of  the  two  Departments  mentioned.    The  puzzling  problem 

'  Mayor  Mitchel  is  in  quite  a  measure  forcing  cooperation,  but  the  extent  to  which 
this  policy  may  be  carried  is  problematical,  and,  even  though  successful,  may  not  be 
continued  by  a  succeeding  mayor. 


768  HOSPITAL  COMMITTEE 

of  how  far  the  Health  Department  shall  go  in  the  curative  field  would  also 
be  solved  by  a  consolidation  of  the  Departments. 

Theoretically,  a  consolidation  of  all  of  these  Departments  is  desirable. 
The  practical  difficulties,  however,  are  great.  The  details  to  be  handled  in 
such  a  consolidated  department  probably  would  be  as  great  as  those  of  all 
the  other  Departments  of  the  City  combined,  and  the  annual  expenditures  of 
this  consolidated  department  would  be,  including  the  cost  of  public  patients 
in  private  hospitals,  fully  $16,000,000.00.  The  head  of  such  a  Department 
would  outrank  all  other  Commissioners,  and  in  order  to  secure  a  man  com- 
petent to  fill  the  position  it  would  be  necessary  to  pay  a  salary  not  ma- 
terially less  than  that  now  received  by  the  Mayor.  The  deputies  to  be  as- 
sociated with  such  a  directing  head  should  not  be  of  less  caliber  than  the 
Commissioners  at  the  head  of  the  existing  Departments,  and  it  probably 
would  be  difficult  to  secure  men  of  standing  to  fill  these  subordinate 
positions. 

Another  suggestion  is  that  the  Department  of  Bellevue  and  Allied  Hos- 
pitals be  absorbed  in  the  Department  of  Public  Charities.  This  seems  but  a 
partial  solution.  The  Board  of  Trustees  of  Bellevue  and  Allied  Hospitals, 
though  manifesting  many  shortcomings,  nevertheless  has  greatly  advanced 
hospital  practice,  while  politics  has  been  aboHshed  from  the  Department 
and  its  services  have  improved  accordingly.  The  Department  of  Public 
Charities  has  been  stimulated  by  the  example  set  by  Bellevue.  To  absorb 
the  Bellevue  hospitals  back  into  the  Department  of  Public  Charities  would 
seem  to  be  a  backward  step,  and,  moreover,  were  this  done,  the  contagious 
disease  hospitals,  including  especially  part  of  those  caring  for  tuberculosis, 
would  still  remain  under  the  control  of  the  Department  of  Health.  A  con- 
sistent policy  of  handling  the  tuberculosis  problem  would  not  result  from 
such  a  readjustment. 

It  has  been  proposed  that  a  department  be  formed  to  administer  all  hos- 
pitals, and  that  the  Department  of  Public  Charities  retain  the  almshouses 
and  the  other  problems  now  assigned  to  this  Department.  But  the  tendency 
of  almshouses  by  necessity  is  to  develop  hospitals  for  cases  of  sickness,  since 
a  majority  of  almshouse  inmates  are  ill.  Hospitals  first  came  into 
existence  in  this  City  in  this  way.  It  is  highly  probable  that  were 
almshouses  alone  to  remain  in  the  Department  of  Public  Charities  hos- 
pitals would  gradually  develop  in  connection  with  them.  Therefore,  to 
Insure  that  all  hospitals  shall  be,  and  continue  to  be,  in  one  department  the 
almshouses  must  be  included  with  the  hospitals  in  any  scheme  of  consolida- 
tion. 

Were  a  hospital  department  formed  some  would  advocate  that  the  hos- 
pitals for  contagious  cases  remain  in  the  Health  Department.  It  would 
seem  practicable  to  make  this  classification,  provided  the  hospitals  for  con- 
tagious diseases  received  only  quarantinable  diseases,  and  all  other  con- 
tagions and  infections,  such  as  tuberculosis  and  venereal  diseases,  be  as- 
signed to  a  hospital  department.  However,  while  this  classification  or 
assignment  would  undoubtedly  work,  there  seems  to  be  no  strong  reason 
why  the  hospitals  for  contagious  diseases  should  not  be  included  with  all 
other  hospitals  in  one  department.  The  Health  Department  has  power  to 
control  the  admission  and  discharge  of  contagious  cases  in  whatever  hos- 
pital, and  it  also  has  power  to  dictate  the  treatment  and  care  of  such  cases. 
This  power  would  safeguard  its  obligations  and  responsibilities.  But  were 
the  contagion  hospitals  in  a  department  with  all  other  hospitals  a  better 
distribution  of  contagious  cases  might  be  effected. 


PROBLEMS  COMMON  TO  DEPARTMENTS  769 

It  does  seem  highly  desirable  to  consolidate  the  Department  of  Belle- 
vue  and  Allied  Hospitals,  the  Department  of  Public  Charities,  the  Board 
of  Ambulance  Service,  the  Board  of  Inebriety,  and  the  Hospital  Admission 
Bureau,  and  to  omit  from  such  consolidation  that  part  of  the  work  of  the 
Department  of  Health  not  connected  with  hospitals. 

A  consolidated  department  should  be  presided  over  by  a  single  head,  and, 
doubtless,  opinions  would  differ  as  to  the  method  of  selecting  this  head. 
The  reasonably  good  record  of  the  Bellevue  Department  would  argue  the 
advisability  of  providing  a  board  of  trustees,  with  power  to  appoint  a  com- 
missioner and  to  formulate  policies.  Such  a  system  in  most  regards  would 
be  desirable,  for  it  would  tend  to  eradicate  politics  from  the  department 
and  would  insure  a  competent  commissioner.  The  chief  value  of  a  board  of 
trustees  would  seem  to  be  to  maintain  a  consistent  program  and  policy.  On 
the  other  hand,  trustees  many  times,  though  conscientious,  are  inclined  to 
let  one  strong  man  in  the  board  dominate,  which  domination  tends  to  conflict 
with  the  administrative  head ;  and  such  conflict  results  in  scattered  responsi- 
bility and  inefficiency. 

An  appointee  by  the  Mayor  might  be  dominated  by  political  affiliations 
and  a  change  in  policy  might  occur  in  each  administration.  These  consid- 
erations must  be  carefully  weighed.  But  somewhat  counterbalancing  them 
is  the  fact  that  a  mayor  is  very  sensitive  to  public  criticism  and  would  be 
inclined  to  hold  his  commissioners  closely  to  the  demands  of  the  public. 
And,  too,  more  rapid  progress  is  likely  to  be  made  by  a  commissioner  ap- 
pointed by  a  mayor  than  one  whose  appointment  is  made  by  a  board  of 
trustees.  All  things  considered,  it  seems  advisable  to  provide  that  the 
proposed  consolidated  department  be  headed  by  a  Commissioner  appointed, 
as  are  other  commissioners,  by  the  Mayor.  To  secure  continuity  of  service 
and  an  assurance  of  competence  it  might  be  well  to  provide  that  the  Mayor 
appoint  only  the  Commissioner  and  a  Deputy,  and  that  all  other  heads  be 
Civil  Service  appointees. 

The  proposed  department  should  have  a  number  of  bureaus,  each 
headed  by  a  Chief.  The  following  bureaus  are  suggested :  i,  Hospitals  and 
Homes;  2,  Private  Institutions;  3,  The  Unemployed;  4,  Engineering. 

This  organization  may  be  charted  as  follows : 


770 


HOSPITAL   COMMITTEE 


Commissioner 
Deputy  Commissioner 


Chief  of 
Bureau  of  Hospitals  and  Homes 


I    .  I    .                  I    .                  I  .                 I    .                  I    . 
Superin-  Superin-        Superin-        Superin-  Superin-  Superin- 
tendent of  tendent  of  tendent  of     tendent  of  tendent  of  tendent  of 
Division  of  Division  of  Division  of  Division  for  Division  of  Di\'ision  of 


General       Infectious 
Hospitals        Disease 
Hospitals 


City 
Homes 


Chief  of 
Bureau  of  Private  Institutions 


Convales- 
cents and 
Field 
Work 


Admissions  Collections, 
(Including    Removals, 

Hospital  and 

Admission    Complaints 

Bureau) 


Chief  of 
Bureau  of  Unemployed 


Chief 
Engineer 


Superin-        Superin- 
tendent of     tendent  of 
Division  for  Division  of 
Children     Institutions 


Superin-  Superin-  Superin- 
tendent of  tendent  of  tendent  of 
Municipal  Division  of  Division  of 

Lodging  Employ-  Inebriety 
House            ment 


Suggested  Salaries 

Commissioner $10,000 

Deputy  Commissioner 7.50O 

Chief  of  Bureau  of  Hospitals  and  Homes          ....  6,000 

Chief  of  Bureau  of  Private  Institutions 5,ooo 

Chief  of  Bureau  of  Unemployed S.ooo 

Chief  Engineer S,ooo 

Superintendent  of  the  Division  of  General  Hospitals         .         .  4,000 

Superintendent  of  the  Division  of  Infectious  Disease  Hospitals  4,000 

Superintendent  of  the  Division  of  City    Homes          .         .         .  3,500 

Superintendent  of  the  Division  of  Convalescents  and  Field  Work  3,500 

Superintendent  of  the  Division  of  Admissions    ....  3,500 
Superintendent  of  the  Division  of  Collections,  Removals,  and 

Complaints 3>5oo 

$60,500 

Included  in  the  above  list  are  three  positions  recommended  in  other  sec- 
tions of  the  Report  of  this  Committee  as  being  necessary  for  the  adequate 
handling  of  the  problems  in  connection  with  the  Department  of  Bellevue 
and  Allied  Hospitals  and  the  Department  of  Public  Charities.  These  posi- 
tions are :  a  Superintendent  in  charge  of  the  problem  of  convalescents ;  a 
Superintendent  of  a  division  for  collections  and  removals ;  and  a  Superin- 
tendent of  City  Homes.  The  aggregate  salaries  of  these  is  $10,500.  The 
salaries  of  the  officers  at  present  performing  all  of  the  functions  indicated 
by  the  above  list,  with  the  exception  of  the  new  positions,  aggregate  $54,700. 


PROBLEMS  COMMON  TO  DEPARTMENTS  yjl 

The  present  positions,  with  the  salaries  indicated,  are  as  follows: 

Commissioner $7,5oo 

Three  Deputies      .        . 15,000 

General  Medical  Superintendent,  Department  of  Public  Charities  6,000 

Chief  Engineer 4,SOO 

General    Inspector 3,000 

Superintendent,  Bureau  of  Dependent  Adults     ....  2,700 

Director,  Board  of  Ambulance  Service 5,000 

Bellevue  Administration,  present  cost $12,000 

Cost  of  positions  to  be  retained         ....       7,000 

Net  present  cost 5,ooo 

Superintendent,  Contagious  Disease  Hospitals     ....      3,000 
Secretary,  Board  of  Inebriety 3,ooo 

$54,700 

Since  the  total  proposed  expenditure  for  the  salaries  of  administrative 
officers  for  the  suggested  consolidated  department  is  $60,500,  and  the  amount 
at  present  expended  for  these  functions  is  $54,700,  the  proposed  department 
shows  an  increased  expenditure  of  but  $5,800,  with  three  new  positions  in- 
cluded among  the  officers  of  the  proposed  department. 

The  duties  of  the  officers  of  this  proposed  department  may  be  described 
as  follows: 

The  Commissioner  and  Deputy  Commissioner,  to  be  appointed  by  the 
■Mayor,  would  have  entire  charge  of  the  department  as  administrative  of- 
ficers, performing  functions  common  to  such  heads.  By  having  one  com- 
missioner in  charge  of  the  various  bureaus  indicated,  the  conflicts  and  mal- 
adjustments heretofore  noted  as  at  present  existing  between  departments 
should  be  obviated.  All  of  the  sick  and  dependent  of  the  City  would  be 
cared  for  by  this  department.  One  commissioner,  having  charge  of  the 
entire  problem,  would  be  able  to  make  such  classification  of  hospitals  and 
bureaus  as  would  most  adequately  perform  the  functions  now  inadequately 
performed  because  of  their  distribution  among  several  departments.  The 
tuberculosis  problem  would  be  handled  as  a  whole  by  this  department,  with 
the  possible  exception  of  the  field  clinics  operated  by  the  Health  Department, 
if  these  be  omitted.  Likewise,  the  problem  connected  with  the  care  and 
treatment  of  venereal  diseases  would  be  consistently  handled.  The  distribu- 
tion of  chronic  cases  would  be  subject  to  the  control  of  the  Commissioner, 
and  the  character  of  the  cases  to  be  treated  in  each  hospital  would  be  pre- 
scribed by  him.  He  would  be  enabled  to  provide  better  training  for  internes 
and  nurses  by  assigning  them  for  stated  periods  to  specialized  hospitals. 

The  immediate  administration  of  the  various  problems  of  the  depart- 
ment would  be  in  the  hands  of  Chiefs  whose  tenure  of  office  would  be  made 
secure  by  Civil  Service  regulation.  All  the  hospitals  and  homes  would  be 
grouped  together  in  one  division,  inasmuch  as  they  involve  similar  prob- 
lems of  administration,  especially  in  the  care  of  the  physical  plant,  the  pur- 
chasing of  supplies,  and  the  feeding  of  patients  and  inmates. 

All  the  problems  in  connection  with  the  care  of  City  patients  in  private 
institutions  and  the  placing  out  of  children  would  be  under  the  supervision 
of  one  Chief. 


772  HOSPITAL   COMMITTEE 

The  problem  of  the  unemployed  would  be  under  another  Chief.  He 
would  have  supervision  of  the  Municipal  Lodging  House  and  all  employ- 
ment bureaus  which  the  City  may  see  fit  to  operate,  and  such  other  prob- 
lems as  might  arise  in  connection  with  the  unemployed.  He  would  also 
supervise  the  Farm  for  Inebriates. 

The  Chief  Engineer  would  be  in  charge  of  all  the  engineering  problems 
of  the  proposed  department. 

The  hospitals,  according  to  the  plan,  would  be  divided  into  two  groups; 
namely,  general  hospitals  and  infectious  hospitals,  with  a  Superintendent  in 
charge  of  each  group. 

The  City  Homes  (almshouses)  would  constitute  another  group,  in  charge 
of  a  Superintendent.  This  is  a  new  office  and  is  required  by  the  many  prob- 
lems which  have  not  been  adequately  handled  heretofore  in  connection  with 
the  almshouses.  The  employment  and  care  of  inmates  of  these  Homes 
have  not  received  the  attention  that  they  should  have  received. 

Another  innovation  proposed  in  the  plan  is  that  of  a  Division  for  Con- 
valescents and  Field  Work,  in  charge  of  a  Superintendent.  Up  to  the 
present  time  the  City  has  made  almost  no  provision  for  the  care  of  con- 
valescing patients  in  their  homes,  or  institutions  other  than  the  hospitals. 
Marked  economies  could  probably  be  secured  by  providing  convalescent 
homes  and  by  caring  for  convalescing  patients  in  their  own  homes.  This 
officer  would  also  have  charge  of  the  work  in  connection  with  the  Health 
Centers  proposed  by  the  Committee. 

Admissions  to  the  Homes,  which  are  now  provided  for  by  the  Bureau  of 
Dependent  Adults,  would  be  in  charge  of  the  Superintendent  of  a  division 
performing  similar  functions.  This  officer  would  also  supervise  the  Hos- 
pital Admission  Bureau  for  the  admission  of  tuberculous  patients. 

Another  of  the  new  officers  proposed  is  a  Superintendent  of  a  Division 
for  Collections,  Removals,  and  Complaints.  As  set  forth  in  the  report  of 
this  Committee  under  the  subject  of  Aliens,  Non-Residents,  and  State  Poor 
in  City  Institutions,  the  City  is  at  great  expense  at  the  present  time  in  caring 
for  non-residents  and  dependent  aliens,  and  a  large  amount  of  money 
could  be  saved  by  having  such  matters  in  charge  of  a  competent  officer  to 
make  collections  where  possible  and  to  remove  when  found  advisable.  This 
officer  would  also  handle  all  complaints. 

It  is  believed  by  the  Committee  that  the  proposed  department  suggested 
is  advisable,  feasible,  and  would  result  in  much  greater  efficiency  in  the 
care  and  treatment  of  the  sick  and  dependent,  and  would  also  result  in 
marked  economy,  and  the  Committee  recommends  that  legislation  be  en- 
acted providing  for  its  creation  and  installation. 

It  is  difficult  to  select  a  name  for  such  a  consolidated  department.  The 
name  "Public  Welfare  Department"  would  be  very  appropriate  were  the 
Department  of  Health  included  in  the  consolidation,  but  without  the  in- 
clusion of  this  Department  the  term  is  rather  too  broad  in  scope.  The  term 
"Public  Care  and  Welfare"  would  be  a  somewhat  more  restricted  title,  and 
would  describe  fully  the  work  to  be  carried  on  in  the  proposed  department. 
The  name,  "Welfare  Department,"  or,  "Social  Welfare  Department,"  would 
also  be  appropriate. 

Should  the  consolidation  be  brought  about  it  would  not  render  needless 
the  reorganization  of  Bellevue  Hospital  suggested  in  Part  i  of  this  Section. 
The  only  necessary  change  in  the  plan  as  proposed  would  be  the  substitution 
of  the  word  Commissioner  for  Board  of  Trustees. 


INDEX 


INDEX 


Admissions  to  City  Homes  (Almshouses)  page 

Summary  of  Findings 31-32 

Conclusions 32-33 

Recommendations 33 

Investigation 

(Synopsis) 249-255,    324-325 

City  Homes: 

Almshouses  at  time  of  consolidation  of  the  Boroughs 249 

Almshouses,  how  and  by  whom  operated 249 

Almshouses,  History  of  the 250-258 

Dependents: 

Admission,  Avenues  of 249-250,  256,  271,  281-282 

Admission  of  a  former  U.  S.  soldier. 290 

Admission  of  a  widow  of  a  U.  S.  soldier 280 

Admissions,  Authority  for 249-250,   257-258,  271-274,   282-284,   285 

Admissions,  Investigation  of,  required  by  City  Charter 252,  278,  287 

Admissions  not  investigated 253,  255,  260,  280,  285,  287,  290 

Admissions,  Records  of,  compared 270,  271,  272,  281 

Admissions  studied  for  certain  periods ._ 249,  256,  273,  281 

Admissions  without  sufficient  information 251,  253 

Aliens 253,  254,  262,  263,  264,  265,  266,  279,  280,  288,  289,  290 

Causes  of  dependence 256,  271,  281 

City  Farm  Colony 281-291,  318-323 

Admission,  Avenues  of 281-282 

Admission  of  a  former  U.  S.  soldier 290 

Admissions,  Authority  for 282-284,  285 

Admissions,  Investigation  of,  required  by  City  Charter 287 

Admissions  not  investigated 285,  287-290 

Admissions,  Records  of,  compared 281 

Admissions  studied  for  certain  periods 281 

Aliens 288,  289,  290 

Causes  of  dependence 281 

Classification  according  to  recorded  addresses 286-287,  289 

Classification  according  to  findings  of  field  work 288,  289 

Expense. 288-289 

Illustrative  cases 291 

Non-residents 290 

Readmissions 284,  285 

Records  at  Bureau  of  Dependent  Adults,  Richmond 285,  286 

Records  described 286 

Records,  Incompleteness  of 285,  286,  287,  289 

Tables 318-323 

Transfers 282,  283,  284 

City  Home  for  the  Aged  and  Infirm,  Brooklyn  Division 270-280,  305-317 

Admission,  Avenues  of 271 

Admission  of  a  widow  of  a  U.  S.  soldier 280 

Admissions,  Authority  for 271-274 

Admissions,  Investigations  of,  required  by  City  Charter 278 

Admissions  not  investigated 280 

Admissions,  Records  of,  compared 270,  271,  272 

Admissions  studied  for  a  certain  period 273 

Aliens 279,  280 

Causes  of  dependence  not  recorded 271 

Classification  according  to  recorded  addresses 278 

775 


776  INDEX 


Classification  according  to  findings  of  field  work 279 

Discharges 258,  259,  274,  275 

Expense 279 

Non-residents 279,  280 

Readmission,  Regulations  for 275 

Readmissions 274-276 

Records  at  Bureau  of  Dependent  Adults,  Brooklyn 273 

Records  at  Deputy  Commissioner's  OfBce,  Brooklyn 276 

Records,  Incompleteness  of 276-278 

Removals 280 

Tables 305-317 

Transfers 271,  272,  274 

City  Home  for  the  Aged  and  Infirm,  Manhattan  Division 256-269,  291-304 

Admission,  Avenues  of 256 

Admissions,  Authority  for 257-258 

Admissions  not  investigated 260 

Admissions  studied  for  certain  periods 256 

Aliens 262,  263,  264,  265,  266 

Causes  of  dependence 256 

Classification  according  to  recorded  addresses .260-262,  264 

Classification  according  to  findings  of  field  work 262,  264 

Discharges 258,  259 

Expense 262-263,  264 

Illustrative  cases 266^-269 

Non-residents 265-266 

Readmissions 258,  259 

Records  at  Bureau  of  Dependent  Adults,  Manhattan 259-260 

Records  described 260 

Records,  Incompleteness  of 259,  260-262 

Removals 265-266 

Tables 291-304 

Transfers 250,  257,  258,  259 

Classification  according  to  recorded  addresses.  252,  253,  260-262,  264,  278,  286- 

287,  289 

Classification  according  to  findings  of  field  work 253,  262,  264,  279,  288,  289 

Discharges 258,  259,  274,  275 

Expense 253-254,  262-263,  264,  279,  288-289 

History  of  care  given 250-258 

Illustrative  cases 266-269,  291,  327-346 

Non-residents 254,  265-266,  279,  280,  290 

Readmission,  Regulations  for 250,  275 

Readmissions 258,  259,  274-276,  284-285 

Records,  Incompleteness  of,  in  the  almshouses.  .254,  259,  260-262,  276-278,  285, 

286,  287,  289 
Records,  Deficiency  of,  in  the  Bureaus  of  Dependent  Adiolts .  .  .254,  260,  285,  286 

Records  described 260,  286 

Records  in  the  Bureaus  of  Dependent  Adults 259-260,  273,  285,  286 

Records  not  used  to  best  advantage 253,  255 

Removals 254,  265-266,  280 

Tables 291-325 

Transfers 250,  257,  258,  259,  271,  272,  274,  282,  283,  284 

Appendix  (illustrative  cases) 327-346 

Aliens  in  City  Institutions 

Summary  of  Findings 21-23 

Conclusions 24-25 

Recommendations 28-30 

Foreword 103-1 13 

Previous  Presentations  and  Legislative  Provisions 1 15-120,  123-124 

Investigation 

Dependence  (from  all  causes) : 

Bellevue  Hospital,  In 125-151,  205-245 

Classification 126 

Condition,  Physical 141-144,  146-149 

Condition,  Social 141-144 


INDEX  777 


Deportable 126,  127,  133,  134,  135,  136,  137,  142-149,  151 

Deportations I35-I39,  145-146 

Diagnoses  of  ailments 13 1-133 

Excludable 146-149 

Expense 125-128,  137-138,  143-146,  151 

Illustrative  cases i33-i35 

Improperly  admitted  to  U.  S 127,  133,  136 

Seamen 149 

Department  of  Public  Charities,  In  Institutions  of 152-16 1 

Admitted  to  almshouses 253,  254,  262,  264,  265,  279,  288 

Expense 153,  155,  254,  263,  266,  279,  289 

Deportable 151,  152-153.  I55,  i6i 

Deportations 152-154,  159-161,  254,  265,  280,  290 

Expense: 

Appropriations  by  the  State,  1876,  1880,  1881 107,  108 

Bellevue  Hospital,  In 125-128,  137-138,  143-146,  151 

Bonds  and  commutation  payments  abolished,  1876 107 

Bonds  from  masters  of  ships 104 

Commission  of  Emigration  (New  York  State)  responsible 105 

Commission  of  Emigration  (New  York  State)  disputes  responsibility.  .105-106 

Commutation  payments  for|each  immigrant 105 

Contract  with  the  Federal  Government 108,  109 

Department  of  Public  Charities,  In  institutions  of .  153-155, 254,  263, 266,  279, 289 

Federal  relief  insufficient 110-112 

Federal  relief  in  the  States  of  New  York  and  Massachusetts  compared.  112-1 13 

How  met 103 

Originally  met  by  local  authorities 103-108 

Tax  imposed  by  State  for  each  alien  landed  at  Castle  Garden,  1882.  . .         108 
Tax  imposed  by  State  upon  steamship  authorities  for  each  alien  landed, 

1824 104,  105 

Tax  imposed  by  U.  S.  Government  instead  of  the  States,  1882 108 

Federal  Government  undertakes  responsibility 108 

Foreign  bom  inmates  of  municipal  institutions 11 5-1 17 

Municipal  problem,  A 103 

Provision,  First 103 

State  Commission  of  Emigration  disputes  its  responsibility 106 

State  undertakes  care 105 

Deportable 117-119,  126,  127,  133,  134,  135,  136,  137,  138,  142-149,  151,  152- 

153,  155,  161 

Deportation,  Process  of 118,  119,  124,  135,  136,  137 

Deportation  limited  to  within  one  year,  1882 109 

Deportation  limited  to  within  three  years,  1891 109 

Deportations : 

Agencies  for 108,  1 17-1 19 

Bellevue  Hospital,  From 135-139,  145-146 

Comparison  of  removals  by  State  and  Federal  agencies no,  120,  124 

Department  of  Public  Charities,  From  institutions  of .  . .  .152-154,  159-161,  254, 

265,  280,  290 

Examinations  by  Federal  authorities 147-149 

Excludable 117-118,  146-149 

Exclusions  authorized,  1882,  1891,  1907,  1913 108,  109,  no,  117 

Exclusions  reported  for  1912 117 

Landings  under  supervision  of  municipal  authorities 103 

Landings  under  supervision  of  Federal  authorities 109 

Legislation : 
Federal — 

Deportation  limited  to  within  I  year,  1882 109 

Deportation  limited  to  within  3  years,  1891 109 

Exclusions,  1882,  1891,  1907,  1913 108-110 

Deportations,  1907 1 17-1 18 

Responsibility  limited  to  I  year,  1882 108-109 

Tax  imposed  by  U.  S.  Government  and  the  States  to  be  relieved,  1882.         108 
State — 

Bonds  and  commutation  payments  declared  unconstitutional  by  U.  S. 

Supreme  Court 107 

Bonds  from  masters  of  ships,  1824 104 


778  INDEX 

PAGE 

Classes  defined  for  which  the  Commission  of  Emigration  was  to  be 

responsible,    1855 106 

Commission  of  Emigration  created,  1847 105 

Descriptions  of  passengers  to  be  reported  to  the  Mayor,  1824 104 

State  Board  of  Charities  authorized  to  remove 117-118 

State  Hospital  Commission  authorized  to  remove I18 

State  Department  of  Labor  authorized  to  remove 1 19 

Tax  imposed  for  each  alien  landed  at  Castle  Garden,  1882 108 

Tax  imposed  upon  steamship  authorities  for  each  alien  landed,  1824.  .  104,  105 
Municipal  problem  (see  New  York  City) 
National  problem  (see  United  States) 
New  York  City : 

Bonds  from  masters  of  ships 104 

Descriptions  of  passengers  to  be  reported  to  the  Mayor,  1824 104 

Dependence,  in  Bellevue  Hospital  [See  Dependence  (from  all  causes)], 

125-151,  205-245 
Dependence,  in  institutions  of  Department  of  Public  Charities  [See  De- 
pendence (from  all  causes)] ....  153-161,  253,  254,  262,  263,  264,  265,  266,  279, 

280,  288,  289,  290 

Federal  relief  insufficient i  lo-i  12 

Foreign  born  inmates  of  municipal  institutions 1 15-1 17 

Landings  under  supervision  of  municipal  authorities 103 

Provision  for  dependence,  First 103 

Serious,  First  became 103 

New  York  State: 

Appropriations,  1876,  1880,  1881 107,  108 

Bonds  and  commutation  payments  abolished,  1876 107 

Commission  of  Emigration,  Responsibility  of 105 

Commission  of  Emigration  disputes  responsibility '. . . .  105-106 

Contract  with  Federal  Government 108-109 

Contrasted  with  Massachusetts 1 12-1 13 

Deportable 118-119,  127,  133,  134,  135,  136,  137,  152-153,  155,  161 

Deportation,  Process  of 1 19,  124 

Deportations 137,  138,  139,  145,  146,  152-154,  159-161 

Deportations  authorized 108,  117,  1 19 

Deportations,  Comparison  of no,  120,  124 

Deportations,  Period  for,  not  limited 108,  155 

Legislation  (see  Legislation) 

Undertakes  to  provide 105 

Reported  for  investigation  and  possible  removal 153 

Seamen 149 

State  problem  (see  New  York  State) 

Tables 162-194,  196-201,  203-204 

United  States: 

Action  upon  State's  handling  of  problem 107 

Assumption  of  responsibility 108 

Contract  with  the  State 108,  109 

Deportable 117-118,  126,  133,  134,  135,  136,  137,  138,  142-149,  151,  152, 

153,  161 

Deportation  limited  to  within  i  year,  1882 109 

Deportation  limited  to  within  3  years,  1891 109 

Deportation,  Process  of 118, 135-136,  137 

Deportations 136,  137,  138,  139,  146,  152,  153,  154,  160,  161 

Deportations  authorized 108,  117-118 

Deportations,  Comparison  of 1 10,  120,  124 

Examinations  at  landing 147-149 

Excludable 1 17-1 18,  146-149 

Exclusions  authorized,  1882,  1891,  1907,  1913 I08-1 10 

Exclusions  reported  for  1912 117 

Improperly  admitted  to  U.  S 127,  133,  136 

Landings,  Supervision  of 109 

Legislation  (see  Legislation) 

Relief  to  the  City  insufficient I  lO-l  12 

Seamen,  how  admitted 149 

Tax  imposed  and  States  relieved no 

Appendix  (illustrative  cases) 205-245 


INDEX 


779 


PAGE 

Autopsy  Findings  in  Bellevue  Hospital  Compared  with  Clinical  Diagnoses 

Summary  of  Findings 37-38 

Conclusions 38 

Recommendations 38 

Investigation 

Anatomical  Material  in  Johns  Hopkins  Medical  School 364 

Anatomical  Material  in  University  of  Pennsylvania 364 

Anatomical  Material  in  University  of  Virginia 364 

Anatomical  Material,  Report  of  committee  on 363,  364-365 

Bellevue  Hospital,  In 361-362,  365 

Illustrative  cases 365-366 

Results  of,  compared  with  clinical  diagnoses 365-366,  367 

Bodies  ordered  held  for  teaching  purposes 362 

Consents 361-362,  367 

Knowledge  of  anatomy  and  disease.  Growth  of 361 

Law,  Amendment  to,  recommended 367-368 

Law,  References  to  the 362-363,  367 

Percentage  of,  performed  in  hospitals  in  United  States  and  Europe 361 

Restricted 362 

Results  reveal  average  percentage  of  correct  diagnoses 366-367 

Character  and  Costs  of  Hospital  Buildings 

Summary  of  Findings 91-93 

Conclusions 93-94 

Recommendations 94 

Foreword 633 

Examination 

Suggested  Standards: 

Administration  unit 650-651 

Bathroom 638,  651 

Calls,  nurses 639 

Clothes  closets 654 

Day  room 637 

Doors 653 

Dormitories 650 

Elevators 654 

Equipment 654 

Exterior 653 

Floor  space.  Division  of 638 

Floors,  Materials  for 639-640 

Grounds 655 

Heatiag 650-651 

Help's  quarters 649 

Kitchen 647-648,  654 

Laundry 649 

Linen  room 638,  654 

Lighting 638-639 

Medicine  closets 654 

Nurses'  residence 646 

Plumbing 651-652 

Roof  ward 637 

Serving  kitchen 637,  654 

<  Sink  room 637,  654 

Site,  The. 635-636 

Staff's  residence 649 

Storehouse,  General 648-649 

Surgeon's  bowls 638,  652 

Transoms 653 

Trim. 653 

Ventilating 652-653 

Walls 653-654 

Walls,  Color  of,  in  wards 639 

Ward  toilets 638,  652 

Ward  unit,  The 636-637 

Windows 653 


78o  INDEX 

PACE 

Ward  units,  Examples  of,  and  comments  on: 

Bellevue  Hospital 645-646,  650 

City  Hospital 643,  648,  649 

Kings  County  Hospital 644-645,  647,  648 

Kingston  Avenue  Hospital 640,  649 

Metropolitan  Hospital 643-644,  647,  650 

Riverside  Hospital 640 

Sea  View  Hospital 641-643,  648,  649,  650,  651,  654 

Willard  Parker  Hospital 641 

Investigation 
Costs: 

Area  per  bed.  Floor 659 

Bed,  Per 659 

Cubic  foot.  Per 657-658 

Dormitories 666-670,  680 

Bellevue  Hospital  (new) 669-670 

City  Hospital 668-669 

Greenpoint  Hospital 669 

Metropolitan  Hospital 668 

Riverside  Hospital 667-668 

Standard,  The 666-667 

Willard  Parker  Hospital 667 

Methods  used  in  figuring 657 

Nurses'  Homes 659-666,  679 

Children's  Hospitals 665 

Fordham  Hospital 665 

Greenpoint  Hospital 666 

Kingston  Avenue  Hospital 662 

Metropolitan  Hospital 662-663 

Riverside  Hospital 661-662 

Sea  View  Hospital 663-664 

Standard,  The 659-661 

Square  foot,  Per 658 

Space  per  bed.  Cubic 659 

Standards  for  comparisons 659 

Tables 658,  679-682 

Tuberculosis  pavilions 675-678,  682 

Metropolitan  Hospital 677-678 

Riverside  Hospital 676-677 

Sea  View  Hospital 678 

Standards,  Two 675 

Standard  for  advanced  treatment 677 

Standard  for  open  air  treatment 675-676 

Ward  Buildings 670-675,  681 

Bellevue  Hospital 672-674 

Harlem  Hospital 674 

Kings  County  Hospital 674-675 

Kingston  Avenue  Hospital 672 

Standard,  The 670 

Willard  Parker  Hospital 670-671 

Children's  Services  in  the  Municipal  General  Hospitals  In  Manhattan  and  The  Bronx 

Summary  of  Findings 51-52 

Conclusions 52-53 

Recommendations 54-56 

Arguments  in  Support  of  Recommendations 57-6o 

Investigation 

Accommodations  for  children 414,  423 

Auxiliary  rooms 420 

Classification  and  length  of  stay 414-416 

Contagious  diseases 416,  417,  418 

Convalescents 419 

Cross  infection 413,  418,  419,  420 

Detention  rooms 417 

Diagnoses  of  patients  in  main  wards 417 

Isolation  rooms 42 1 


INDEX  781 

PAGE 

Maps opposite  424 

Normal  children  in  the  wards 417,  418,  419,  420 

Pneumonia  cases,  Care  of 413 

Sources  of  cases  in  municipal  hospitals 42 1-422 

Tables 423,  opposite  424 

TonsU  and  adenoid  cases 420 

Clinical  Records  in  Bellevue  Hospital 

Summary  of  Findings 35 

Conclusions 35-36 

Recommendations 36 

Investigation 

Classification  of  those  examined 351-352 

Illustrative  cases 352-357 

Dependents 

See  Admissions  to  City  Homes  (Almshouses) 

Distribution  of  Ward  Space  in  Bellevue  Hospital 

Summary  of  Findings 39 

Conclusions 40 

Recommendations 40 

Arguments  in  Support  of  Recommendations 41 

Investigation 

Changes  in  system  of  distribution  proposed 373-374 

Changes  in  system  of  distribution  required 373 

Overcrowding  in  wards 371,  372 

Vacancies  in  wards 371,  372 

Tables 374-380 

Employment  of  Dependents 

See  Physical  Examination  and  Employment  of  Dependents  in  City  Homes 

Food  and  Food  Waste 

See  Handling  of  Food  and  Food  Waste 

Forms  for  Internal  Control  of  Bellevue  Hospital 

See  Internal  Control  Forms  Suggested  for  Bellevue  Hospital 

Handling  of  Food  and  Food  Waste 

Summary  of  Findings 81-84 

Conclusions 84-86 

Recommendations 86-89 

Foreword 583-584 

Investigation 

Department  of  BeUevue  and  Allied  Hospitals 585-594,  612-615 

Calories  per  capita  per  day 585,  612-615 

Distribution 585 

Eggs,  Average  monthly  use  of 587 

Eggs,  Per  capita  consumption  of 585,  612-615 

Meat,  Average  weekly  use  of 586 

Meat,  Per  capita  consumption  of 585,  612-615 

Meat,  Saving  in  use  of 594 

'  Meat  used  by  Bellevue  Hospital  in  1912 587 

Milk,  Per  capita  consumption  of 585,  612-615 

Poultry,  Per  capita  consumption  of 585 

Poultry  used  by  Bellevue  Hospital  in  1912 587 

Protein  per  capita 585,  612-615 

Requisitions  for  food,  how  prepared 586 

Waste  of  prepared  food  in  Bellevue  Hospital 587-594 

Waste  of  prepared  food  in  Kings  Park  State  Hospital 589 

Department  of  Health 600-601,  627-630 

Calories  per  capita 600,  629-630 

Meat  consumption  in  tuberculosis  hospitals.  Comparison  of 60  r 

Meat  consumption  in  tuberculosis  hospitals,  Estimating 601,  608 


782  INDEX 

PAGE 

Per  capita  consumption  of  food  compared 600-601 

Protein  per  capita 600,  627-630 

Department  of  Public  Charities 594-600,  616-626 

Accounting  for  food 594,  595 

Budget,  Estimates  for 599 

Calories  per  capita 597,  598,  616-626 

Deliveries  of  food,  Siirinkages  in 595-596 

Distribution  of  food 594,  595 

Eggs,  Per  capita  consumption  of 597,  599,  616-626 

Estimating  yearly  requirements,  Proposed  schedule  for 599-600,  608,  609 

Meat,  Per  capita  consumption  of 598 

Milk,  Per  capita  consumption  of 597,  599,  616-626 

Per  capita  consumption  of  food  compared 597,  598,  599 

Protein  per  capita 597,  598,  616-626 

Wheat  products,  Per  capita  consumption  of 596-597 

General 601-609 

Calories  per  capita 602 

Dietary  table  for  estimating  total  requirements 603-604,  606 

Dietary  table  for  individual  requirements 606,  607,  608,  609 

Dietary  table  used  in  Kings  Park  State  Hospital 603-604 

Estimating  yearly  requirements.  Proposed  schedule  for 607-609 

Meat  rations  suggested  for  hospitals 607,  610 

Per  capita  consumption  of  food  compared 601-602 

Protein  per  capita 602 

Records  to  enable  the  making  of  estimates 603,  opposite  610 

Requirements  of  particular  classes  of  patients,  inmates,  and  employees.  .602,  603 

Requisitions  by  dietitians 607 

Serving  food,  Measuring  utensils  for 605 

Waste  accounting  system  in  Kings  Park  State  Hospital 603,  604-605 

Waste,  Suggestions  for  reduction  of 605-609 

Health  Center 

See  Sickness  in  the  Home  and  Proposed  Health  Center 

Hospital  Helpers 

Summary  of  Findings 77 

Conclusions 77-78 

Recommendations 78 

Investigation 

Budget  allowances 55 1 ,  552 

Comparisons  by  Departments 556-557,  558,  560,  561 

Comparisons  by  Grades: 

Department  of  Bellevue  and  AUied  Hospitals 556,  561,  563,  564 

Department  of  Public  Charities 554-556,  558 

Comparison  of  Bellevue  and  Kings  County  Hospitals 561,  562 

Discharges: 

Percentages  of,  in  Department  of  Bellevue  and  Allied  Hospitals  553,  560,  561,  564 

Percentages  of,  in  Department  of  Public  Charities 553,  558,  559 

Personnel  of,  in  Department  of  Public  Charities 557-558 

Dormitories 564,  565-566 

Food. 564,  565 

Grades  in  various  City  institutions 552 

Institutions  included  in  the  investigation 552-553 

Lengths  of  stay.  Average: 

Department  of  Bellevue  and  Allied  Hospitals 554 

Department  of  Public  Charities 553 

Method  of  the  investigation 552 

Problem,  Statement  of  the 551 

Scope  of  the  investigation 552 

Internal  Control  Forms  Suggested  for  Bellevue  Hospital 

Statement 96 

Recommendations 
Forms: 

Bureau  of  Investigation,  Report  of 694,  698 

Census  report  for  wards 699,  703,  704,  705 


INDEX  783 


Clothing,  Patients' 709,  710,  712 

Condemned  articles 687,  689-690 

Dental  clinic,  Report  of 694,  697 

Diets,  Reports  on  regular  and  special 687,  688 

Drugs,  Accounting  for 690,  691 

Employment  agent.  Report  of 694,  696 

Engineer,  Report  of  Supervising 693-694,  695 

Food  supplies 690,  692-693 

Internes,  Record  of  attendance  of 706-707 

Laundry  accounting 709,  714-715 

Leaves  of  absence.  Record  of 707-708 

Long  Term  patients.  Reports  on 709-716 

Midwives,  .Report  of  the  School  for 706 

Nurses,  Report  of  assignment  of 706,  opposite  706 

Patients,  Notii3cation  slips  pertaining  to 712,  717-721 

Pathological  Department,  Report  of 697,  700-702 

Rontgen  Ray  Department,  Report  of 697,  703 

Social  Service  Bureau,  Report  of 694,  699 

Need,  The 685-687 

Morgue  Service 

Summary  of  Findings 47 

Conclusions 47 

Recommendations 47 

Investigation 

Control  by  Commissioner  of  Public  Charities 403 

New  morgue  in  Bellevue  Hospital 403 

Employees  and  salaries  required  for  its  operation 404 

Use  of,  offered  to  Commissioner  of  Public  Charities 403 

Non-Residents  In  City  Institutions 

Summary  of  Findings 23-24 

Conclusions 26-27 

Recommendations 28-30 

Foreword 113-114 

Investigation 

Bellevue  Hospital,  In 125-135,  137-142,  149-15 1 

Admissions,  Classifications  of 126,  130 

Admissions  without  authority  of  the  charter 126-127 

Classified  according  to  laws  of  United  States  and  New  York  State 127 

Classified  according  to  residence  before  or  after  contraction  of  ailment . .         131 

Condition,  Physical 141-142 

Condition,  Social 141-142 

Diagnoses  of  ailments 131-133 

Expense 125,  129,  138,  149,  151 

Illustrative  cases I33~I35 

Paying  patients 127-130 

Removable 129,  133-135 

Removals 138-139 

Residence  in  City,  Periods  of 129-130,  139,  151 

Residence  in  State,  Periods  of 137-138 

Treatment,  as  provided  in  charter 126 

Department  of  Public  Charities,  In  institutions  of . .  . .  153,  156,  160-161,  254,  265- 

266,  279,  280,  290 

'  Admitted  to  almshouses 253,*254,  262,  264,  265,  279,  288 

Data  too  meagre 156 

Expense 254,  263,  264,  279,  289 

Overseer  of  the  Poor 125,  152 

Removals 124,  153,  160-161,  265,  280,  290 

Reported  for  investigation  and  possible  removal 153 

Exclusion  from  New  York  State,  No  provision  for 120 

Law  of  New  York  State,  Quotation  from 121 

Laws  of  other  States,  Lack  of  uniformity  in 120 

Liability  for  support 121-122 

Provisions  for,  New  York  State  compared  with  Massachusetts 112-113 

Removals: 

Agencies 120 


784  INDEX 

PAGE 

BellevTje  Hospital,  Prom 138-139 

Department  of  Public  Charities,  From  institutions  of ..  .153,   160-161,  254,  265, 

280,  290 

New  York  City,  From 124 

New  York  State,  From 124 

Responsible  officials 121 

Settlement  defined 121 

Tables 162,  164-196,  199-200,  202-203 

Nurses,  Ratio  of 

See  Ratio  of  Nurses  to  Patients  Proposed  for  Municipal  Hospitals 

Out-Patient  Department 

See  Suggestions  for  the  Organization  of  a  Public  Out-Patient  De- 
partment 

Out-Patient  Department  of  Gouvemeur  Hospital,  The 

Summary  of  Findings 69-70 

Conclusions 71 

Recommendations 71 

Investigation 

Clinics,  Character  of  conditions  in 460 

Clinics,  Character  of  service  in 459 

Clinics  selected  for  investigation 459 

Comparison  with  St.  Bartholomew's  CHnic 463 

Contagion,  Danger  of 460,  461 

Contagious  cases.  Treatment  of 46 1-462 

Distrust  of  dispensaries.  Attitude  of 459 

Examinations,  Average  time  of 460 

Examinations,  Character  of 460 

Gouvemeur  Hospital  selected  for  investigation 459 

Illustrative  cases 460-461,  462,  464-465 

Medical  staff 460 

Patients,  Average  number  of  visits  of 463 

Patients  treated  in  a  certain  period 460 

Patients  visited  by  the  investigators 463 

Patients  visited  by  the  investigators,  Findings  as  to 463-466,  468 

Pharmacy 462 

Records 462-463 

Tables 467-468 

Waiting  room.  Condition  of 462 

Physical  Examination  and  Employment  of  Dependents  in  City  Homes  (Almshouses) 

Summary  of  Findings 61-62 

Conclusions 62-63 

Recommendations 63-64 

Arguments  in  Support  of  Recommendations 65-67 

Foreword  (Historical) 427-435 

Investigation 
Employment: 

Character  of  employment  in  almshouses  in  other  cities 439,  451-453 

Character  of  employment  in  the  City  almshouses 437,  454 

Limited  at  present 437 

Occupational  Index  proposed 440,  449-450 

Products  of  dependents  in  almshouses  in  other  cities 451-453 

Products  of  dependents  in  the  City  almshouses 452,  453-454 

Proportions  of  dependents  employed  in  almshouses  in  other  cities. .  .440,  451-452 

Proportions  of  dependents  employed  in  New  York  City  almshouses 439 

Purpose  of  Farm  Colony 438 

Recommendations  of  medical  examiners 448 

Values  of  products  of  almshouse  farms  compared 452-454 

Examination: 

Findings  compared  with  report  of  Department  of  Public  Charities,  19 11.         442 

Findings  of  the  examination  by  Dr.  L.  L.  WUliams 440-443 

Need  of  medical  attention,  present  practice 438 


INDEX 


785 


PACE 

Objects  of  the  examination  by  Dr.  L.  L.  Williams 438-439 

Physical  ability  of  dependents  to  work  not  now  ascertained 437-438 

Physical  ability  of  dependents  to  work,  Present  method  of  determining.  .  438 
Proportions  of  dependents  able  to  work  in  almshouses  in  other  cities.  439,  451-452 
Proportions  of  dependents  able  to  work  in  New  York  City  almshouses.  .439,  441, 

442.  454 

Reasons  for  examinations  of  dependents 443 

Scope  of  the  examination  by  Dr.  L.  L.  Williams 438-439 

System  of  examining  dependents  proposed  in  detail 444-448 

Problems  Common  to  All  the  Departments,  Some 

Statement 98 

Study,  A 

Acute  cases 763,  764,  766 

Acute  service  established  in  Department  of  Public  Charities 763,  766 

Ambulance  districts 763,  764,  766,  767 

Authority,  Division  of 763,  764 

Chronic  cases . 763,  764 

Commission  on  Hospitals,  Recommendation  of 767 

Consolidation  suggested.  Various  forms  of 767-768 

Contagious  cases 763,  766 

Nurses,  Field 766 

Nurses,  Training  of 763,  764,  765 

Overseer  of  the  Poor  needed  in  Bellevue  Department,  Powers  of 765 

Powers  of  Departments  to  erect  new  buildings  compared 766 

Social  service  workers 766 

Tuberculosis  cases 763,  766 

Recommendations 

Consolidated  department,  The  proposed 769-772 

Head,  Functions  of 771 

Head,  The  presiding 769 

Name,  Proposed 772 

Organization 770 

Salaries  of  present  officials 771 

Salaries  suggested 770 

Sub-heads 769 

Sub-heads,  Functions  of 771-772 

Departments  to  be  consolidated 769 

Proposed  Salary  and  Wage  Schedule  for  the  Department  of  Public  Charities 

Statement 79 

Investigation 

Institutions  standardized 569 

Method  of  the  investigation 569 

Schedule,  The: 

Based  on  maintenance  in  institutions 571 

Budget  requirements 571 

Division  between  titled  and  untitled  positions S69-570,  572 

Effects,  Chief 570 

Grades  I  to  XIII,  List  of 572-577 

Promotion 569,  570,  571 

Titles,  Explanation  of 571 

Standardization 569 

Proposed  Reorganization  of  the  Medical  Service  in  Bellevue  Hospital 

Statement 98 

Foreword 727 

Discussion 

Organization,  Present 729-730 

Admission  of  patients 731 

Discharge  of  patients 731-732 

House  Staff 730 

Reorganization,  Proposed 735-759 

Arguments  in  support  of  plan  of 736-739 

Plan  commented  on  by  physicians 743~759 


786  INDEX 

PAGE 

Plan  of 735-736 

Plan  submitted  to  physicians 741 

Results  of  present  medical  service 732-734 

Schools  in  the  Hospital 729,  734 

Visiting  Staff 730 

Ratio  of  Nurses  to  Patients  Proposed  for  Municipal  Hospitals 

Summary  of  Findings 49 

Conclusions 49 

Recommendations 50 

Investigation 

Need  of  the  investigation 407 

Schedule 410 

Schedule  explained  and  illustrated 408 

Schedule,  how  modified 409 

Schedule  referred  to  authorities 408 

Scope  of  the  investigation 407 

Standard  lacking  in  New  York  municipal  hospitals 407 

Uniformity  lacking 407 

Records 

See  Clinical  Records  in  Bellevue  Hospital 

Reorganization  of  Bellevue  Hospital 

See  Proposed  Reorganization  of  the  Medical  Service  in  Bellevue 
Hospital 

Reorganization  of  the  Departments 

See  Problems  Common  to  All  the  Departments,  Some 

Salary  and  Wage  Schedule 

See  Proposed  Salary  and  Wage  Schedule  for  the  Department  of  Public 
Charities 

Sickness  in  the  Home  and  Proposed  Health  Center 

Summary  of  Findings 75-76 

Conclusions 76 

Recommendations 76 

Investigation 

Districts  personally  investigated 529-534 

Lower  East  Side 5^9-532 

West  Side 532-534 

Districts  studied  (Health  Department  statistics) 522-528 

Comparison  of  both  districts 527-528 

Lower  East  Side 523-526,  542,  543 

West  Side 526-527,  544,  545 

Method  of  the  inquiry 521-522 

Need  for  the  study 521 

Solution  of  the  Problem,  Suggested  Health  Centers 535-541 

Argument,  A  brief 54' 

Contagious  cases.  Present  care  of 535-536 

Control  of  the  plant 539 

Cost  of  operations 539 

Diagrams 543i  545 

District  physicians 540-541 

Economic  aspect.  The 536,  540 

Experiment  proposed 536 

Functions  to  be  performed 53^-539 

Location 53^ 

Operation  by  Departments  of  Bellevue  and  Health 536-537.  53^,  539 

Organization 536-537,  538 

Out-patient  departments,  Inadequacy  of  the  City's 536 

Responsibility  of  the  City 535 


INDEX  ySj 


Results  to  be  accomplished,  Outline  of 537 

Tables 542,  544 

State  Poor  In  City  Institutions 

Summary  of  Findings 24 

Conclusions 27 

Recommendations 28-30 

Foreword 114 

Investigation 

Bellevue  Hospital,  In 128-130,  140,  149-150 

Aliens  classed  as  State  poor 128 

Expense 140,  149-150 

Residence  in  City,  Periods  of 129 

Committed  to  the  State  almshouses 122-123,  156-157 

Definition  of,  in  the  law 1 14,  122 

Definition  of,  by  State  Board  of  Charities 158 

Department  of  PubUc  Charities,  In  institutions  of 152-153,  156-161 

Classification  of,  at  variance  with  that  of  the  State  Board  of  Charities. .  .  158 

Committed  to  the  almshouses 156-157 

Expense I57-I59 

Expense  not  collected 153 

Expense  not  paid  by  the  State 159 

Expense  to  be  collected  by  the  Overseer  of  the  Poor 152 

Expense  to  be  paid  by  the  State 156 

Illustrative  cases 159-160 

Overseer  of  the  Poor,  Duties  of 152 

Overseer  of  the  Poor,  The  Commissioner  an 125,  152 

Removals 157,  161 

Inspection  of,  by  the  Committee  on  State  and  Alien  Poor 123-124 

Law  of  New  York,  Quotations  from 122 

Liability  of  the  State 122 

Maintenance  of,  as  prescribed  by  the  Poor  Law 122 

Provisions  for,  New  York  State  compared  with  Massachusetts 114 

Relief  of  municipalities  by  the  State  decreased 123,  157 

Removals 124,  161 

Responsibility  of  the  State  defined 122 

State  almshouses 123,  156 

Tables 163-196,  199-204 

Suggestions  for  the  Organization  of  a  Public  Ovrt-Patient  Department 

Statement 73 

Foreword 471 

Discussion 

Comparison  of  hospital  and  dispensary  cases  in  Bellevue  Department 476 

Dispensary  abuse 477-478 

Fees 478-487 

Functions 475-476 

History 473 

Hospital  cases  in  Bellevue  Hospital,  Study  of 476-477 

Illustrative  cases 480-483 

Nursing  staff.  The 488-489 

Social  service 478-484,  489-490 

Social  service.  Cases  especially  in  need  of 483 

Status,  Present 473-475 

Visiting  nurses  and  social  service  workers  compared.  Duties  of 484 

Visiting  nursing 484,  488-489 

Organization 

Administration 485 

Admissions,  Methods  of 485-486,  495-496,  510-511 

Consultations,  Average  time  of 4S7-488 

Medical  staff 486-487 

Nursing  staff 488-489 

Pharmacy,  Formula  for  the 491 

Records,  Medical 49&-491,  508,  509,  512-514 

Records,  Social 490-491,  507,  509-510 

Social  service  staff 489-490 


788  INDEX 

PAGE 

Plant 

Architecture 493 

Clinics 499-501 

Clinics,  Arrangement  of 498-499 

Clinics,  Sessions  of 497-498 

Construction 493 

Entrances 495 

Exits 495 

Floors 494 

Heating. 493-494 

Illumination 494 

Light 494 

Location ' 492 

Partitions 494 

Plans,  Floor 503-506 

Plumbing 494 

Records,  forms  suggested 507-517 

Seats 496-497 

Site 423 

Size  of  building 492-493 

Type  of  building 492-493 

Ventilation 493-494 

Waiting  rooms 495-496 

Walls 494 

Appendix  (suggested  record  forms) 507-517 

Transfer  of  Patients  to  and  from  Bellevue  Hospital  and   to   and   from   Ellngs 
County  Hospital 

Summary  of  Findings 43-44 

Conclusions , 44-45 

Recommendations 45-46 

General  Statement 383 

Investigation 

Bellevue  Hospital 385-388 

Tables 390-395 

Transferred  from 3S6-388 

Changes  in  method  of  making  transfers  proposed 387,  388 

Changes  in  method  of  making  transfers  required 387,  388 

Character  of  sickness 386 

Death  rate 388 

Disposition  of  patients 387 

Length  of  stay 387 

Transferred  to 385-386 

Character  of  sickness 385 

Death  rate 386 

Disposition  of  patients 385 

Length  of  stay 385-386 

Kings  County  Hospital 388-390 

Tables 396-399 

Transferred  from 389 

Disposition  of  patients 389 

Transferred  to 3S8-389 

Character  of  sickness 388 

Death  rate 389 

Disposition  of  patients 388 

Length  of  stay 389 

Ward  Space 

See  Distribution  of  Ward  Space  in  Bellevue  Hospital 


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